Leadership and its Effects on Employee Wellness and Morale

Introduction
Employee wellness should be a priority for effective healthcare leaders. A commitment to anticipating employee’s needs can go a long way in promoting employee wellness and building morale. Leaders must be cognizant and ready to act upon physical and emotional needs of their employees. Doing so can increase employer commitment to their employees which in turn can increase staff morale and loyalty. It is also important for employees to be encouraged to stay healthy on a personal level in order to optimize personal health. There are a number of cost-effective benefits associated with having a healthier workforce due to decreases in both insurance costs and less worker’s compensation claims for example. Focusing on the healthcare setting where the employees care for patients, a commitment to wellness must be taken seriously in order to ensure a safe environment for both patients and providers. The purpose of this chapter is to discuss some implications to aid in the health of employees and different ways in which leadership can increase employee support. An emphasis will be placed on the health of staff working in a hospital organization.

Employee Wellness Programs
Many employers have opted to engage the organization’s employees into wellness programs. These programs are widely varied depending on the needs and limitations of the organization. Six common themes work site wellness programs may include are: dietary and physical activity interventions, smoking cessation interventions, health-risk appraisal and tailored health advice (stress reduction and coping), comprehensive wellness programs, integration of workplace health and safety policies and practices, and economic programs (Shaw et al., 2012). In order to gauge the needs of an organization’s employees, it may be beneficial to administer surveys in order to make the most impact in terms of programs to make available to staff. For example, if a survey finds that a large percentage of the workforce suffers from obesity, nutrition and physical activity initiatives should be emphasized as part of the program. Another integral part of the survey includes asking what kind of barriers employees foresee as those that would prevent them from participating (Kohler, 2015). This is important in making wellness programs the most meaningful for employees and to try and preventively correct barriers of participation.

Another aspect to consider is what is going to motivate the work force to use the program. Some different motivators that have been assessed to increase participation are monetary rewards and increased time off (Kohler, 2015). Huang et al. (2016) also found an increased participation rate among programs that offered incentives. The two main program types in this study that had the highest participation rate due to incentives were prevention based programs and comprehensive programs that offered a mix of screening, lifestyle, and disease management.

Surveying employees to gauge what would be the most motivating reward for them would aid in the implementation of such a program and the best chance of buy in for participation and sustainability. Contrary to Kohler and Huang, Galinsky et al. (2014) finds that if employees are in a wellness program exclusively for monetary rewards and benefits, this does not prove to be sustainable. Offering incentives to employees pose ethical and economical risks if not used cautiously. Offering incentives based on results or improvements could be helpful in ensuring that employees are utilizing the programs. On the contrary, those employees that are healthy and have no major improvements to be made may be demotivated to utilize programs due to no incentive to do so, so this should be considered when thinking about the diverse health needs of an employee population. Another aspect is the efficacy of programs and ensuring that they are reliable ways to best help employees attain desired results. As in the quality improvement approach of Plan, Do, Check, Act (PDSA) cycles of process improvement, plans can be flexible to employees of an organization and modifications can be made in order to ensure goals are being reached.

The initiation of an employee wellness program is often new and exciting and needs to receive attention and build participation by offering incentives. This so called “action” phase as described by Dr. Steve Aldana is a needed step before the “maintenance” step is achieved which is where maximum benefits of both employee health and employer cost cutting benefits are seen. Therefore incentives, if managed appropriately, are crucial in attracting participants to maximize future benefits.

Any kind of organizational change, such as implementing a new program, should involve staff at all levels of the organization. Buy-in from organizational leadership is important for several reasons. First, the commitment and prioritization of such a program as part of the guiding missions of the organization make it known to staff that their health matters (Reeleder 2006). Leaders who were dedicated to the wellness of their employees and not just focused on economic benefits were found to be the most effective in the implementation of an employee wellness initiative (Kaspin et al., 2013, Brennan, 2013).

Next, these leaders should act as champions for the initiative, such as being the spokespeople to roll-out the program and be committed to its stability. While the executive board is important to a program, the middle managers, front-line staff, and professionals with a background in reaching these health goals (such as dieticians, those specializing in cardiology and endocrinology, money management, psychologists, and occupational health nurses) should all be part of the “wellness committee” when formulating the roll out of such a program. Wellsteps, a research based wellness program initiative, describes this group of employees as a “wellness committee.” Employees are able to participate and feel ownership and buy in. Doing so can aid in proper thought by hospital leadership in order to make sure all stakeholder’s needs are met.

Organizational leadership’s realization of the obesity crisis, the prevalence of heart disease, and other preventable health conditions shows the staff that these leaders are behind the program and are confident in its success for its employees (Kohler et al., 2015). A benefit to employee wellness is that those front-line staff that have the knowledge to get a plan on the ground are integral in the creation of the plan and have the ability to co-create the program and increase their own leadership skills. They are also going back out into the work force to be champions for a more successful wellness program and are able to communicate the program across the organization’s network.

The sustainability of an effective program is one that comes from alignment of the organization’s mission and vision combined with top leadership support in all developmental stages (Marinescu, 2007). Clear guidelines and explanations of links are helpful in how the program aligns in the organization’s values. Decisions will need to be made and communicated to different levels of management as to what their role should or could be with a program. Central organization of a program should be maintained for consistency, but involvement and promotion of a program by all levels of management could be helpful in the longevity of a program as opposed to no direct involvement with the program at all.

Accessibility, simplicity, and adaptability should be part of how the wellness program is constructed (Kaspin, 2013). There are some key points to keep in mind when creating an employee wellness initiative. The first is lead with values. This means starting from the top and leading by example (Kaspin et al.). The next is to keep the program convenient. Resources like on-site clinics staffed by physician’s assistants or nurse practitioners can save paid time off and can lead to reductions of copayments and medical savings for an organization by using these mid-level providers (Galinsky, 2014). Another aspect is to keep it personal and to focus on the employee as a whole and not just physical wellness. A final habit is to share success stories and make it communal so others may relate and see examples of how the program has helped fellow employees.

The more user-friendly a program is, the more the staff will utilize it to reap the benefits. Technology has been studied for utilization in aiding in health risk awareness and education (Kaspin, 2013). Some examples of technologies used are apps, a website with a dashboard of progress, and fitness tracker syncing (ex. Fitbit data uploads to the employees’ profile). However, the use of technology should be something that is used with multiple stakeholders in mind. While some employees would seamlessly adapt to a new employee wellness program platform and be able to easily navigate around it, others may not adjust as easily.

Results achieved after implementing employee wellness programs were studied in a systematic review and some main outcomes of both economic and health-related factors were observed by employers (Kaspin et al., 2013). Economic outcomes that were seen include reduced costs, return on investment, and reduced absenteeism. There was a 1.6 to 3.9 dollar saved compared to dollars spent on average in this large group of organizations studied.

Major health-related outcomes observed include increased exercise level, risk reduction, and smoking cessation. Some of the risk reduction categories that improved through this systematic review include: high blood pressure, high cholesterol, poor nutrition, and obesity. This shows that with wellness programs in place, there are proven cost savings and health-related outcomes that are motivating employees to better themselves with their employer’s help. In addition to what benefits wellness programs can provide, attention must be placed on other needs of employees like proper staffing and workplace safety including implications for the physical demand of a health worker’s job.

When focusing on the whole person as mentioned above, mental aspects should be monitored like the amount of mental stress that is perceived from work and that staff safety is upheld in the workplace. Administrative support is needed for staff safety initiatives that may or may not be part of a formalized staff wellness program (Hooper et al., 2005).

Effects of Poor Health and Morale
On the opposite end of the spectrum, negative and harmful implications of toxic environments include reduced health and morale. The two main themes described are implications to patient care and the economic costs to employers because of low levels of wellness and morale.

The landscape of healthcare is moving towards prioritizing patient experience as hospitals compete against one another to earn business. Special considerations are made when developing hospital blueprints which keeps the patient and their families in mind in order to provide a luxury setting while receiving their healthcare (US News and World Report 2014). HCAHPS (Health Consumer Assessment of Healthcare Providers and Systems), which are surveys sent out to patients discharged from hospitals, show the perception of quality performance. Thirty percent of the decision for Medicare and Medicaid rests on these performance surveys for reimbursement to hospitals (Sherman, 2012). These are also publicly reported in order to promote transparency in the healthcare system. This puts pressure on the staff to maintain physical and mental energy to not only perform their job duties, but to do so in a manner that makes the patient’s experience the best it can be (Gilbody, 2006).

Leaders should further support their staff to ensure high quality outcomes in their organization and benefit from Medicare and Medicaid reimbursements. Gilbody also studied how these pressures accumulated to lead to a decrease in morale and an increase in the amount of sick days taken. Increased numbers of sick days have the potential to lead to understaffing that further push the bounds of safe places for patients. With fewer staff to attend to their needs, patient satisfaction is not only at risk, but this may also put them at risk for adverse events. Increased length of stay was associated with these increases of sick days taken by staff (Gilbody, 2006). This not only increases risks for patients to develop nosocomial infections, it also adds to unneeded costs to the patient and extra cost to a hospital by taking up a room for longer than was necessary (Brimmer et al., 2013).

There is a need to establish a safety culture to best prevent unneeded harm. Hooper et al. (2005) studied how an initiative was started in a hospital in order to change the safety culture. Administrative support was key in this movement. Their involvement is key when there is a need for paralleled attention for patient safety and staff safety because one cannot happen without the other. They reported an overall decrease in injury claims, lost-time injuries, and needle stick injuries because of this paralleled attention and visibility to employee safety. They also experienced claims being reported at a faster rate in order for preventative measures to be taken to ameliorate safety concerns (Hooper et al., 2005). These physical and mental demands intertwine to create the needs and wants of healthcare workers and these problems should be addressed in a preventative nature before excessive mistakes are made.

Attention for organization leaders entails budgetary dollars and administrative initiatives. A Joint Commission of Healthcare Organizations (JCAHO) report brought medical errors to the forefront that found a link between these errors and nurse understaffing (Hooper et al., 2005).
The amount of overtime worked has been found to have adverse effects in the nursing profession (Brimmer, 2013). According to Brimmer, 69% of nursing staff stated they experienced fatigue that made them feel concerned during work in a self-reported study. Sixty-five percent stated they almost made a mistake due to their fatigue, while 27% stated that they had made a mistake due to their fatigue. This model of nurse understaffing adversely effects the quality of care, patient and employee satisfaction, and increases operational costs in hospitals.

Some strategies used to support healthy mental demands in the workplace include the enrichment of clinical skills and increased psychologic support (Gilbody, 2006). A study from Galinsky also shows success from a company that supports the employee from other aspects like financial wellness and career development to further aid in caring for the employee. In Galinsky’s study, each employee fills out a self-assessment and then has a one-on-one session where they set three goals for themselves out of categories like career-development, work-life fit, financial security, community involvement, and physical health. This personal goal setting has led to contained health care costs despite inflation while also maintaining a high employee engagement ranking and low turnover (Galinsky, 2014).

Some other hidden costs to employers are related to turnover and employee satisfaction. If an environment does not provide support to its employees, high turnover could be a result of these stresses (Gilbody, 2006). Those who choose to not switch jobs but continue to be dissatisfied would not promote others to apply for a job in the same organization, potentially turning away good candidates for jobs. When a hospital is in a competitive market and wants to recruit the best of the best, these programs and benefit packages from employers could tip the scale for the best prospective employees and be a draw to work for an organization.

Mandatory overtime was linked to more musculoskeletal problems in a longitudinal study by Trinkoff et al (2006). An added area that requires attention is the phenomenon of presenteeism, which describes the employee working in pain or reporting to work but contributing less to the overall lab’s productivity and quality of work (Campo & Darragh, 2012). Presenteeism has been studied in other professions, and it has the potential to cause deleterious productivity or quality of work (Campo & Darragh, 2012).

Physical Job Demands and Employer Commitment
It is no secret that working in the healthcare field puts physical strains on employees. There have been many research studies reporting physical strain that is caused by caring for patients (Da Costa et al 2010). Musculoskeletal injuries of the back, shoulders, and knees result from long periods of standing, lifting patients and equipment, and other physical obligations of the job. Leadership must be aware of the issues behind these barriers and be willing to help with redesign or purchase of devices that may improve workplace safety for employees. Da Costa et al. (2010) performed a systematic review of recent longitudinal studies on work-related musculoskeletal disorders. In their findings, they saw what types of movements and actions at work were typical for injuries in certain anatomical areas. They also studied different demographic and psychosocial risk factors that made injuries more common. There are two findings that stood out from this study. The first finding showed that risk factors working concomitantly, like high psychosocial stress and heavy lifting together, accelerated injuries. The other was that low back pain, which is the most commonly reported painful area among healthcare workers, has certain risk factors like heavy lifting, awkward and repetitive postures, and high BMI. The idea of high BMI is something that a wellness program would want to help reduce in order to also lower the risk for low back pain in this population.

Like athletes must condition themselves to best play their own sport, so must hospital employees condition themselves to best reduce injury inflicted during work. Emphasis from the employee wellness program to work on building strength could help with reducing injuries to promote a focus on strength for those employees that must transport, position patients, and use heavy equipment. Another way that leadership would be able to combat physical injuries would be to offer stretching and yoga seminars that can improve flexibility and mindfulness of the way they are moving in order to reduce injuries.

In an article from Bauman et al. (2015), a staff empowerment approach was utilized to best improve staff safety, health, and wellness. These front-line staff members were first educated about safety skills and what some workplace hazards to safety may be. Armed with this information, they went to their work environments and were able to make suggestions in order to modify their work environment. This cognizance of leadership’s commitment to safety improved the safety culture of the organization and resulted in staff to demonstrate low risk behaviors. This can be contributed to leadership giving the employees ownership of their work environments in order to make a bigger impact than if leaders would have mandated a certain way to change things. A similar physical result may have been achieved, but there is an added benefit of employees stepping up and being a leader in the origination of their own staff safety initiative.

Another initiative would be for leaders to provide funding to purchase equipment to aid staff in the lifting of patients and equipment. Hoyer lifts are a popular tool that mounts in the ceiling of a patients’ hospital room and are used to lift a patient out of bed. Necessary arrangements must be engineered in these patient rooms in order for the lifts to be installed. Another example is to have a robot system that is able to transport dirty linens or garbage as opposed to staff members pushing these heavy carts to their destinations.

Mental Job Demands and Employer Commitment
Leaders should be concerned for the psychosocial demands employees face while in the workplace (Martin et al., 2014). In the healthcare setting, there are many contributors to the decline of mental wellness. While an employer is not in control of how patients act or their degree of illness, they expect that the staff provides the best possible care and safety of patients. This can be extremely stressful for employees in terms of mental energy used to accomplish this in some circumstances. Supporting employees through these difficult encounters and overall mental health is paramount of leaders to be appreciable of and to offer a sounding board willing to provide support and resources.

Employees should maintain a sense of psychological safety such that if they were struggling mentally with the demands of their work, they could feel safe in going to their leader and bringing up their concern in order for it to be addressed. Instead of having concerns come to a final “breaking” point, care must be taken to prevent a health behavior crisis. Hours worked, workload, and other considerations should be managed between leaders and followers in order to best manage these working conditions. High workloads and time pressures as part of job demands have shown to be correlated with higher amounts of exhaustion and disengagement in nurses (Demerouti et al., 2000). Demerouti et al. goes on to explain how different job conditions induce stress reactions and can in turn decrease overall life satisfaction. A way to combat this is for supervisors to create a healthy work environment and to promote a joint role in decision making. An additional way to combat this is encouraging leaders to complete frequent meetings with their followers to give and receive feedback so that they can best lead their followers. This would also allow followers to better communicate with their leaders what is working and what they think can also be improved.

Leadership Techniques and Theories for Achieving Employee Wellness
This topic reflects the ethical obligations of a leader to ensure that their staff is well taken care of and all their needs are met or excelled to achieve the highest functioning organization as possible. This can be best fortified by a leader’s inherent values towards their job. Being an ethical leader means being sensitive to other’s needs and caring for others (Northouse, 2016). The root of these ethics not only can promote health in employees, but these employees can in turn strengthen the organization. A well-studied approach to leadership is transformational leadership. Northouse describes transformational leadership as the ability for a leader to inspire followers and encourage them to reach their goals. There are four major components of transformational leadership which include: idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration (Northouse, 2016). Followers’ needs should be understood and leaders should have adaptability in order to reach their goals. This leadership type is seen as a role model to its followers and therefore followers trust the leader and want to achieve higher standards. This inherent quality of a leader that has a focus on values and morals would be beneficial in the promotion of employee health and wellness.

Barling et al. (2002) described that the four studied components of transformational leadership have been shown to align with creating a better safety climate through metrics, including perceived safety climate, safety consciousness, and safety-related events. Better results are achieved by leadership putting more focus on improving the lives of employees through workplace wellness initiatives than they do by financial savings as seen by Galinsky et al. (2014). More specifically, the concept of safety-specific transformational leadership, as studied by Mullen et al. (2009), delves more into transformational leadership as it pertains to safety and the environment for the staff.

Another leadership concept is positive organizational leadership when particular attention is being given to motivating the workforce to latch on to new ideas and initiatives. According to Oades et al. (2011) there are five routes to well-being, including positive emotions, engagement, relationships, meaning, and accomplishment. This study was used in a University setting but specifically looked at employee stress and student well-being. These techniques could be transferrable to a staff working in a hospital setting that have high performance goals as those in a university setting. Using these principles to motivate staff to actively participate in a work place wellness program or the improvement of staff safety culture could benefit an organization for things to move in a positive direction.

Summary
The ideas presented in this chapter are multifactorial in nature, with the main point being that employee wellness must be maintained for factors of personal health, mental wellness, and a reduction of injury. Leadership support is integral in the change of culture to one that’s focus is this. Two major ways that this can be facilitated include employee wellness programs and initiatives to ensure employee workplace safety.

This culmination between promoting employee health, both mental and physical, and creating a safe work environment for employees are all obligations that a leader should be cognizant of and able to adapt to ensure that their employees are well taken care of. There have been research positively linking the health of the employee to the outcomes for patients. This can promote a strengthened and supported team that has the capability of promoting organizations to function at a high level.