Piecing It Together

In the midst of what seems like a groundswell of programming around mental health and substance abuse awareness in the legal profession, these initiatives are often bundled into broader understandings of “well-being.” Indeed, as we see in “Operationalizing Well-Being,” many law firms are developing new roles, committees, and programs expressly centered on the well-being of their lawyers and staff. The proliferation of well-being initiatives raises important questions: What does “well-being” actually mean? What is the relationship between well-being and mental health, substance abuse, or even work/life integration and fulfillment? How should organizations structure their thinking about well-being, and how can law firms learn from other industries?

To help answer these questions, in this article we take a closer look at these broad but increasingly prevalent terms like “well-being” and “wellness.” First, we step back to consider the concept of well-being and its component parts by speaking with Isaac Prilleltensky, professor of educational and psychological studies, vice provost for institutional culture, and now the inaugural Erwin and Barbara Mautner chair in community well-being at the University of Miami. Then, we look at how the concept of well-being is applied in an organizational context by examining the implementation of workplace wellness programs. The Practice spoke with Ron Goetzel, senior scientist and director of the Institute for Health and Productivity Studies at the Johns Hopkins Bloomberg School of Public Health and vice president of consulting and applied research for IBM Watson Health to explore how organizations interpret the concept as well as their role in supporting the well-being of their employees. Finally, we ask Prilleltensky and Goetzel how they might approach creating workplace wellness programs from the ground up—how to not only define well-being but incorporate it into strategies that support and improve the well-being of employees.

Defining well-being

As we navigate this inherently nebulous term, it is worth offering one caveat at the outset: There is no single definition or measure of “well-being.” Public health perspectives often focus more on environmental factors through frameworks like the social determinants of health, whereas some psychological perspectives might instead emphasize interpersonal factors or subjective factors. Others have looked at economic considerations, and some root their understanding in physical manifestations of well-being. Yet, while there are any number of ways of understanding well-being, it is also problematic to operate without boundaries—if for no other reason than discussion can quickly devolve into a case of anything and everything. Therefore, operating under a broadly agreeable and inclusion understanding of wellness is critical if the legal profession is to make strides in addressing it.

Prilleltensky and his team offer one helpful, multidimensional approach to understanding well-being that incorporates many of the various angles noted above: the I COPPE Scale. In short, the idea is that an individual’s overall well-being—and how organizations might therefore develop ways of addressing it—might be broken down into six component parts: interpersonal, community, occupational, psychological, physical, and economic. “We call them ‘domains,’” Prilleltensky explains. In the positive sense, each might be thought to be associated with one’s satisfaction and, in the negative, dissatisfaction. Together, they form a holistic understanding of well-being. Each domain can be understood as follows:

Interpersonal: Interpersonal well-being is about an individual’s satisfaction with their relationships—namely with people close to them. The quality of relationships with family, friends, and colleagues bear heavily on one’s interpersonal well-being.

Community: Community well-being applies to an individual’s connection to a wider group, whether that be their neighborhood, their school, or another association. As Prilleltensky notes, community well-being tends to correspond to a sense of belonging as well as one’s level of community participation.

Occupational: Prilleltensky and his team define occupational well-being by one’s primary occupation, whether paid or unpaid, self-employed or part of a large organization. On this sense, occupational well-being includes the breadwinners and stay-at-home parents alike. Of critical importance in occupation well-being is overall satisfaction with the work you consider to be the main focus of your productive energies.

Psychological: Psychological well-being corresponds to emotional health. Distinct from overall well-being, Prilleltensky notes, psychological well-being denotes how an individual experiences their emotions and the range of satisfaction they can derive from that experience. “Mental health,” as it is commonly understood, is thus not limited to psychological well-being in this framework but extends across multiple dimensions depending on the particulars of the case.

Physical: Physical well-being can be thought of in terms of one’s satisfaction with their own physical health, broadly construed. Note that this is not about illness or disability, but rather contentedness with the nature of one’s physical experience.

Economic: Economic well-being, as one would expect, centers on financial health. “The theory of economic well-being is that we need to reach a certain threshold to experience overall well-being, a certain threshold of economic resources,” explains Prilleltensky. “And the research essentially says that more money doesn’t necessarily make you happier, but less than a certain threshold will make you less happy.”

It is important to stress that none of the domains are hermetically sealed. Indeed, the very point of the model is to stress the inherent interrelatedness of each of the domains of well-being. As such, they might be thought to exist as a grand Venn diagram with overall well-being operating at the center (see below). Each domain, though distinct, has clear implications for each of the others. If an individual is financially stressed, that will take a toll on their psychological well-being. If one struggles in their physical experience, their relationships or work might suffer. If a person feels isolated or at odds with their community, that will almost certainly weigh on their emotional health and in turn affect other areas of their life. To take an example virtually everyone is grappling with at the time of this issue of The Practice, COVID-19 has brought wellness debates to the forefront and, indeed, underscores the multidimensional nature of well-being itself. What are the interpersonal impacts of social distancing? How are communities maintaining bonds when gatherings are prohibited? How are colleagues, many working from home, working together, and how has the nature of their work changed? What are the psychological impacts of all this disruption and segmentation? What are the physical impacts, of both the virus and children who are not in school? And what about the millions of individuals who are losing income as businesses close? Questions like these drive to the heart of the interrelated nature of wellness debates—and the need for holistic understandings and interventions.

It is also worth reiterating that the I COPPE model is simply one way to think about well-being, and Prilleltensky and his team are careful (and meticulous) in emphasizing that there are many other conceptions out there. However, I COPPE’s integrated model is useful insofar as it identifies a whole series of factors—domains—that contribute to an individual’s overall well-being. In fact, many organizations, including Harvard and the American Bar Association, have highlighted comparable multidimensional interpretations of well-being for the benefit of their respective constituencies. A multidimensional approach along these lines allows us to address specific components with perhaps a more concrete understanding of what we are trying to accomplish.

Workplace wellness programs

Scan most organizations’ websites and you are likely to find some reference to employee wellness. Often there are only vague commitments to overall employee wellness—whatever that is meant to mean. Other times there will be lists of resources, both internal and external to the organization, relating to issues like mental or physical health. And, increasingly, there may be internal personnel (see “Operationalizing Well-Being”) listed who are in charge of advancing well-being internally. To better understand these well-being functions—how they operate, how they have grown over time, and how some have succeeded—The Practice spoke with Ron Goetzel, director of the Institute for Health and Productivity Studies at Johns Hopkins, who has spent his career researching and consulting on workplace wellness programs.

The overall purpose of an organization may be to build cars or develop new software, but to do that you need healthy employees.

Ron Goetzel, director of the Institute for Health and Productivity Studies at Johns Hopkins

Notwithstanding big pushes in recent years, Goetzel notes, some workplace wellness programs go back half a century to the 1960s and 1970s, with many beginning as executive health programs. “Back then, companies mostly wanted to keep their executives healthy, so they would provide them with screenings and personalized medical care,” he explains. Larger-scale programs, he adds, did not take off until closer to the 1980s and into the 1990s. Today, four out of every five employers with more than 50 or more workers will claim to have a wellness program in place. The programs themselves, Goetzel notes, can vary widely in comprehensiveness, but as a starting point he references the Centers for Disease Control and Prevention’s definition of a workplace wellness program: “a coordinated and comprehensive set of strategies which include programs, policies, benefits, environmental supports, and links to the surrounding community designed to meet the health and safety needs of all employees.” To add context, Goetzel explains that there are three broad buckets of increasing complexity that one might use to categorize today’s workplace wellness programs:

Feel-good. The first bucket Goetzel refers to as the “feel-good” workplace wellness programs. In this bucket, there might be, for example, a page on the company’s website or intranet with tips for healthy eating, exercise, and stress management. Often, the company’s health plan is used as a primary vehicle for the wellness program, offering gym discounts or the like. And, while there may be some degree of internal organizational promotion of the program, the substance itself is minimal and often derivative. In the end, the feel-good workplace wellness plan boils down to a broad encouragement to stay healthy. “They look and sound good, but ultimately they don’t do very much,” Goetzel summarizes.

Traditional. The second bucket is what Goetzel calls the “traditional” wellness plans, which build on those that sprung up beginning in the 1970s, 1980s, and 1990s. He notes that traditional wellness programs tended to prioritize exposing workers to a “culture of health” through new offerings facilitated by the organization. He points to Johnson & Johnson’s Live for Life program, where he worked for a time as vice president of data analysis, as a helpful example of a traditional workplace wellness program:

In the late 1970s, their CEO, Jim Burke, said, “I want to make Johnson & Johnson employees the healthiest in the world because I think that’s going to improve our morale, our attraction and retention of talent, health care utilization and costs, absenteeism, and it’s the right thing to do.” The CEO brought together health education people, but also marketing people, to try to sell the idea of health promotion and wellness to the masses. And, importantly, Johnson & Johnson emphasized measuring outcomes to improve the program and make sure it was living up to those standards.

A part of the equation for employers using the traditional approach might also be return on investment (ROI). Indeed, Johnson & Johnson estimates that its wellness program saved the company more than $250 million in the first decade of the 21st century. Health and science journalist Christopher Wanjek notes in a 2013 white paper that a number of other large companies have recorded significant ROI from such wellness programs. For instance, Coors Brewing Company estimated a $6.15 boost in productivity for every dollar spent on food and fitness. Travelers Insurance likewise reported a $3.40 gain for every dollar spent on nutrition and recreation, while DuPont reported a $2.05 bump from each dollar spent in those same areas. Today, offerings under these “traditional” approaches might include aspects of education, often in the form of webinars and speaker events, to instill healthy behaviors and reinforce support from company leadership. Components could include areas like nutrition, smoking cessation, fitness, screenings—aspects of (often physical) health and well-being with clear impacts on productivity and the organization’s bottom line.

Wellness goes way beyond physical health.

Ron Goetzel

Holistic. The third bucket goes even further to encompass more dimensions of well-being and could potentially involve many different parts of the organization—what Goetzel refer to as “holistic” wellness programs. Holistic efforts bring together a broad swath of an organization’s key stakeholders, including benefits, human resources, operations, and even new wellness professionals, among others (see “Operationalizing Well-Being”). “Essentially what they’re trying to do is create a coalition of forces within the organization that are all directed toward a common goal,” says Goetzel. That goal, he stresses, is alignment around the purpose of the organization. He explains:

The overall purpose may be to build cars or develop new software, but to do that you need healthy people—healthy employees. You need to make sure that they’re not in the hospital, they’re not home sick, that their attention is focused, that they’re not falling asleep on the job, and that they have good social relations with one another. You want to make sure that they’re not having safety problems, that they feel their organization is fair, that their grievances are handled fairly, and that there are opportunities for career advancements. You want them to recommend their company to other people looking for a job. All of these factor into perceptions of wellness, and in that way, it is a multidimensional concept.

In describing the holistic model for workplace wellness plans, Goetzel explains how organizations might begin to approach Prilleltensky’s multidimensional approach to wellness:

Wellness goes way beyond physical health. Wellness leads you to think about emotional health. For instance, how does your organization deal with anxiety and stress and depression—even violence. What about financial health? Does it provide you with a 401(k) plan? Does it provide you opportunities to invest in the company itself, in an employee stock ownership plan, or some other way of having ownership of the company? Are the wages fair? Can you get time off? Are the benefits reasonable? And then, you get into intellectual health. Is it providing you clear growth opportunities, training, a way to allow you freedom to go a little bit outside the lane sometimes, if that’s where you want to go, to be creative? And then, one final category—though there are many more—but the one final category might be a kind of spiritual health, which means that your values in life align with the company values.

As Goetzel describes, organizations are increasingly taking the holistic approach in their wellness programs, including increasingly law firms (see “Operationalizing Well-Being”). These comprehensive programs are more likely to incorporate factors perhaps not traditionally associated with well-being like flexible work schedules, professional development opportunities, and community service projects. For this holistic approach to work, however, Goetzel stress that creating an overall culture of wellness is crucial, including having champions of the wellness program throughout the organization. “You’ve got to have a combination of senior executives saying this is important and the grassroots, the people actually doing the work, saying this is a good idea,” explains Goetzel. “That requires a degree of internal trust and a culture around these issues.”

How to build a workplace wellness program

As the vice provost for institutional culture and the Erwin and Barbara Mautner chair in community well-being at the University of Miami, these are issues Prilleltensky grapples with directly. “We’re trying to create a workplace environment where everybody feels like they matter, to create a culture of mattering where everybody feels valued and everybody adds value,” he says. Establishing that culture of well-being, he notes, is crucial to that effort. Prilleltensky continues:

For example, you will find a great deal of interest around mindfulness meditation when it comes to workplace well-being—and I applaud this to a certain extent. But mindfulness will never replace the need for a healthy workplace culture. So, the changes are not just internal but also in how we behave toward one another.

Culture first, programs second.

Isaac Prilleltensky, the inaugural Erwin and Barbara Mautner chair in community well-being at the University of Miami

In this spirit, creating a culture, Prilleltensky explains, is the first place he’d start in building a workplace wellness program. “Before I get into what specific program components we might try—a nutrition program or an exercise program or a mindfulness program—I would create a task force with senior management representation to define the culture you want to create,” he says. As part of this process, Prilleltensky stresses the need to do a bit of soul searching to think through some potentially abstract but fundamental questions regarding organizational values. He offers some examples of how an organization might work through this difficult terrain:

Psychological safety in the workplace is one example. Amy Edmondson from Harvard Business School has done a lot of work on the importance of psychological safety. So, whatever the values are—compassion, fairness, empathy, you name it. We have to have a clear vision of the culture of health and wellness we want to create, we have to have values that represent that, and you have to hold people accountable, to lead by example. And then, once you have a clear concept of the culture of health and wellness you want, then you develop a program.

Using that vision as a foundation, Prilleltensky explains, you can start to develop the programming and systems needed to support it. “But none of that will really fly—not sustainably, anyway—without settling that culture question first,” he adds. “Culture first, programs second.”

Goetzel offers three concrete steps organizations can take to establish a wellness program that works. First, engage workers at all levels of the organization. “Rather than waking up one morning and deciding to create a program or have a consultant come in and tell you how to do it, bring in the people who will benefit the most from it and have a discussion,” Goetzel says. And, importantly, this should be done on an ongoing basis—not just at the beginning of the process. Indeed, right in line with Goetzel’s advice, the second step of the ABA’s eight-step action plan for legal employers in its lawyer well-being tool kit (just after enlisting leaders) is to launch a well-being committee.

Second, Goetzel urges employers to implement a program using evidence-based approaches. “For example, the ‘biggest loser’ approach—not a good basis for a wellness program,” he says. “Having healthy choices in the cafeteria, having lower prices for healthy food, having salad bars accessible—all those things are proven to be much more effective at getting people to eat healthier than forcing them to lose weight.” Organizations should focus on hiring the right people to run their wellness programs and providing them with budgets sufficient enough to deliver on their goals.

The changes are not just internal but also in how we behave toward one another.

Isaac Prilleltensky

Third, organizations need to track and evaluate results throughout the process. A big part of that, Goetzel notes, is deciding on the key measures of success at the outset. Organizations need to define success before they can declare their wellness programs successful. “Figure out what the measures are and put them in place,” he says. “Create a baseline. And then keep monitoring that and putting in a feedback loop so that you can fine-tune along the way. This isn’t working—we’ve got to change it. This is working—let’s do more of it.” This way, Goetzel explains, organizations can avoid finding out their wellness programs are ineffective or unpopular only after spending valuable time (and funds) implementing them.

Start at the beginning

As legal employers reevaluate their workplace wellness efforts or consider initiating new ones, a good place to start is determining how the organization defines the well-being it seeks to support and improve. And as more organizations revisit their employee well-being strategies, there will surely be new developments that will help shape larger trends in workplace wellness programs. Prilleltensky notes, for example, that the University of Miami is developing a Masters in Well-Being program designed for midcareer and senior-level administrators and other professionals in organizations to equip them with a broader skill set capable of tackling these issues from an institutional perspective (Kirkland & Ellis’s firmwide director of well-being position shows that law firms are perhaps already thinking along these lines—see “Operationalizing Well-Being”). As this space develops, and whatever specific programs emerge, organizations across industries will have to grapple with questions of culture as they seek to implement efforts tailored to their workers’ needs.