Starting the 'Fire' Under an Unmotivated Employee

AN employer of any size is always seeking a way to reduce the costs associated with absenteeism, injuries, worker's compensation claims, insurance claims, and/or poor morale. With our aging workforce and the natural risks associated with aging, time and efforts may seem fruitless. However, Occupational Health & Safety (November 2002) reports the World Health Organization identified for the first time 10 risk factors contributing to disease and death (World Health Report 2002-Preventing Risks, Promoting Healthy Life).

These preventable risk factors "account for about 40 percent of the 56 million deaths worldwide annually and one-third of global loss of healthy life years." Intervention on a governmental and industrial-led level would have major benefits.

Given this, the employer adopts a safety/wellness program. The appointed Safety Officer or Wellness Coordinator is challenged to design a program that attracts and motivates employees to embrace safe work ethics or take on a healthy lifestyle of exercising, eating right, and more. Ultimately, a safe and healthy workforce will reduce high absenteeism, injuries, high worker's comp claims, and high insurance claims and will increase morale.

However, the best-planned program initially attracts many employees, but once the novelty wears off, all you are left with are the "worried well" (those employees who routinely take care of themselves, have few days off, rarely get injured, or have no need for health care, except for preventive visits) and a few high-risk employees: the unmotivated employees, or, as I call them, the "frequent flyers" (those employees who routinely use as many days possible to take off work, are accident prone, and have not seen a physician for years).

Not all employees will participate because "it's good for them." They'll participate when they get the right answer for "What's in it for me?" Therefore, the next step to enticing more "frequent flyer" participation in safety/wellness activities is for the program coordinator to persuade the CEO to offer incentives for achievement of specific criteria. Incentives can range from cheap items like pens or pencils, to T-shirts and sweatshirts or cash. But, again, your incentive program attracts a few more employees, but the "worried well" control the majority.

Before you scratch your head too hard trying to figure out why your well-planned program does not attract and keep all employees, we need to understand human behavior--more specifically, hierarchy of need, readiness to change, motivation, and incentives.

Maslow's Hierarchy of Need
Abraham Maslow, a psychologist and motivation theorist, identified five levels of need or motives to human behavior. At the bottom of the hierarchy is the strongest need--physiological needs, then safety needs, belonging needs, esteem needs, and self-actualization needs. Usually, it is a requirement for each motivator to be satisfied before the higher need can be fulfilled; however, most practitioners agree these needs interconnect.

I have heard time and time again from people at the administrative level and from wellness personnel that employees should participate in wellness programs because "it's good for them" and "it is the best thing for them." In essence, this attitude is attracting employees who have already moved through Maslow's hierarchy of need and are striving to achieve esteem needs or self-actualization. These employees strive for being their best, rising to their full potential, achieving inner peace and harmony. You are attracting the exact population that you already have--the "worried well." The population you have is one that wants to be its best in all facets of life and is actively doing something to achieve that.

This way of thinking leaves behind the employee who is striving to meet his/her basic physiological needs or safety needs. His or her motivation is not based on who or what he can become, but on putting food on the table or a roof over his head.

Transtheoretical Model of Stages of Change
Combine Maslow's theory with the next theory for discussion--Transtheoretical Model of Stages of Change by James Prochaska. His Transtheoretical Model of Stages of Change identified six stages of behavior change: precontemplation, contemplation, preparation, action, maintenance, and termination.

A precontemplator has no intention of changing an unhealthy habit, no matter what you say or do. Do you remember "You can lead a horse to water but you can't make him drink"? This is basically the idea of this stage. You can use any tactic you want to convince the employee that quitting smoking or starting an exercise program is the best thing for him, but he is not going to change.

A contemplator intends to change within the next six months. Her awareness of the risks and benefits of an unhealthy habit has heightened enough for a change to take place.

An employee in the preparation stage intends to take action within the next 30 days and has taken some behavioral steps in a positive direction.

The difference between the next two stages, action stage and maintenance stage, is that the overt behavior has been changed for less than six months for action and the overt behavior has been changed for more than six months for maintenance.

Termination means the overt behavior will never return, and there is complete confidence that relapse will not happen.

Prochaska's model identifies readiness to change. What motivates one person can be very different for another (Maslow's hierarchy of need). Understanding what will motivate the "at-risk" employee using the Transtheoretical Model can be difficult. A practitioner needs to use several different techniques of motivation to be successful. It is common for a person to move back and forth through the stages. This can take place for a long period of time until termination occurs.

Information by means of flyers, paycheck stuffers, self-guided learning tools, e-mails, home mailings, electronic board messages, and many more needs to be continual to affect a precontemplator and to reinforce the active decision of the employee in the preparation stage.

Motivation
B.F. Skinner, a behaviorist, concluded that everything we do and are is shaped by our experience of punishment and rewards. Today, incentives or rewards are used to affect the behavior of children. Psychologists and behaviorists advocate "catching" a child doing good behaviors and rewarding that behavior instead of correcting an unwanted behavior. By reinforcing a positive behavior, the child will repeat that good behavior.

Skinner also believed that rewarding parts of the wanted behavior would lead to the final wanted behavior.

As we get older, we never outgrow the notion of wanting recognition for doing good things. The incentive/reward may be different but the intent is still there. Frequency is also standard. This means, to have a wanted behavior repeated, the initial reward needs to be appropriate and at frequent intervals. Over time, frequency can decrease because the wanted behavior has become the norm.

Letting the Theories Work for You
Maslow, Prochaska, and Skinner had theories pertinent to understanding human behavior. Understanding these theories will help you with implementing an effective employee program that will focus on decreasing health care costs, worker's compensation claims, and absenteeism costs.

Most safety/wellness programs offer incentives or rewards for meeting specific goals. Many times, however, incentives are given one time per year, and it takes an employee several months to an entire year to achieve the required measures. This kind of timeframe can and does lead to injury hiding, cramming to get points at the last minute, or "fudging" the truth just to get the reward. The goal is too far out of reach. Which behavior has changed? The purpose of a safety/wellness program is to elicit positive long-term behavior change not short-term.

From what you have learned to this point about human behavior, does a reward given once a year change unwanted ("at-risk") behaviors to wanted behaviors? Absolutely not! OK, you might have a few, but you do not have enough to justify your efforts.

Maslow says everyone is motivated by different needs. Prochaska says everyone is at different readiness levels. And, Skinner says rewarding parts of the whole will get you the behavior you want. Tell me, does rewarding one time a year fit into these notions of behavior change? You end up rewarding those who already behave the way you want because it is not a problem for the "worried well" to meet the year-long goals. Rewarding once per year is not changing the behaviors of "high-risk" employees.

Some administrators consider incentives to be bribery. Adult employees are still human and behavior is a lifelong process, so change can occur at any time. Remember, behavior change does not stop once you've reached a certain age. At the work site, behavior is changed with frequent recognition and with positive reinforcement.

To change an employee's risky behavior to a safe or well one, rewards need to be frequent and at all levels of readiness. They need to be given for the slightest hint of a wanted behavior and to an exceeded behavior. They don't need to be extravagant, but the significance needs to match the behavior and the employee's wants.

This article originally appeared in the March 2003 issue of Occupational Health & Safety.

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