McKinsey Quarterly

The overlooked essentials of employee well-being

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Workplace stress is exacting an ever-higher physical and psychological toll. It adversely affects productivity, drives up voluntary turnover, and costs US employers nearly $200 billion every year in healthcare costs. Many companies are aware of these negative effects, and some have gotten busy devising ways to counteract them. Efforts range from initiatives to encourage sleep, exercise, and meditation to perks such as nap pods and snack bars.

In the midst of all this activity, it’s easy to overlook something fundamental: the work environment, starting with the work itself. For many years, a number of researchers, including myself, have touted the benefits of better work practices for performance and productivity. In my new book, Dying for a Paycheck (HarperCollins, 2018), I’ve tried to show how two critical contributors to employee engagement—job control and social support—also improve employee health, potentially reducing healthcare costs and strengthening the case for them as a top management priority.

In this article, I’ll explore the research that connects these two elements to employee health, and describe some examples of organizations that are succeeding at providing the autonomy, control, social connections, and support that foster physical and mental well-being. Any company, in any industry, can pull these levers without breaking the bank. Today, though, too few do.

Job control

Studies going back decades have shown that job control—the amount of discretion employees have to determine what they do and how they do it—has a major impact on their physical health. Recent research also indicates that limited job control has ill effects that extend beyond the physical, imposing a burden on employees’ mental health, too. Organizations can guard against these dangers by creating roles with more fluidity and autonomy, and by erecting barriers to micromanagement.

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Physical and mental health

One of the most notable research efforts in this area was the Whitehall Studies, conducted by British epidemiologist Michael Marmot and his team, which examined employees within the British Civil Service. Marmot’s team discovered that the higher someone’s rank, the lower the incidence of and mortality from cardiovascular disease. Controlling for other factors, it turned out that differences in job control, which were correlated with job rank, most accounted for this phenomenon. Higher-ranked British employees, like higher-ranked employees in most organizations, enjoyed more control over their jobs and had more discretion over what they did, how they did it, and when—even though they often faced greater job demands.

Additional Whitehall data related work stress, measured as the co-occurrence of high job demands and low job control, to the presence of metabolic syndrome, a cluster of risk factors that predict the likelihood of getting heart disease and type 2 diabetes. Employees who faced chronic stress at work were more than twice as likely to have metabolic syndrome compared with those without work stress.

Other research has also found a relationship between measures of job control and health. A study of 8,500 white-collar workers in Sweden who had gone through reorganizations found that the people who had a higher level of influence and task control in the reorganization process had lower levels of illness symptoms for 11 out of 12 health indicators, were absent less frequently, and experienced less depression. And that’s far from the only example of job control affecting mental- as well as physical-health outcomes. For example, a study of individuals at 72 diverse organizations in the northeastern United States reported statistically significant, negative relationships between job control and self-reported anxiety and depression.1

Learning, motivation, and performance

During my research, peoples’ stories painted a vivid picture of how low job control is all too common in many offices today. I heard much about the ever-evolving performance-evaluation criteria that made it tough to know how to succeed; the business trips rearranged without explanation; and even about a workplace “scout” who had to discern the boss’s mood and alert the others.

The picture isn’t pretty, and it can be costly. A chaotic workplace environment of frequent, uncontrollable events adversely affects people’s motivation, their cognition and learning, and their emotional state. If, through their actions, people cannot predictably and significantly affect what happens to them, they are going to stop trying. Why expend effort when the results of that effort are uncontrollable, rendering the effort fruitless?

That’s why research shows that severing the connection between actions and their consequences—leaving people with little or no control over what happens to them at work—decreases motivation and effort. It significantly hampers learning on the job, too. People’s ability to learn by observing the connection between actions and their consequences normally permits them to attain some degree of mastery over their environment—an understanding of what they must do to achieve the desired results. In a condition of low job control, on the other hand, people have less responsibility and discretion, which undermines their feelings of competence and accomplishment and ultimately contributes to stress, anxiety, and depression.


The hidden value of organizational health—and how to capture it

Simple steps toward control and autonomy

When you’re a child, the people in your life—teachers, parents—tell you what to do. As you get older, you begin to make your own life choices. And then one day, you get a job. Depending on your boss, your employer, and the design of your work, your choices about what to do and how to do it, at least while at work, can disappear—leaving you more stressed, more vulnerable to ill health, and, sometimes, less than yourself. There are some straightforward actions companies can take to avoid creating such an environment.

Guard against micromanagement

Micromanaging is all too common at work, simply because many managers are poor at coaching and facilitating others to do their jobs better. When managers micromanage their subordinates, those individuals lose their autonomy and sense of control to the bosses who won’t delegate.

Work doesn’t have to be this way. The founder of Patagonia, Yvon Chouinard, thought of the company as a place where “everyone kind of knows the role that they need to do, and does that work independent of extreme management.” He leads using a principle he calls “management by absence.” The company reduces the risk of micromanagement by having a flat organizational structure, with more people than any manager could possibly micromanage even if he or she wanted to. Similarly, at Zillow, as a learning-and-development person there put it, “the manager’s role is to support the team and be there to help remove roadblocks, not to be the dictator.” The head of human resources at Landmark Health agreed, saying, “If somebody feels like the work that they’re doing is not valued, if they personally don’t feel like they have a voice at the table, if they feel like they’re dictated to or micromanaged, they’re going to feel less fulfilled and more tired.”

Incorporate more autonomy and fluidity into every role

People often believe that providing job control is possible only for some jobs, and for some people. But that is not the case—all people can be given more decision-making discretion in their jobs and latitude to control their work. San Francisco–based Collective Health designed the jobs of its “patient advocates”—who answer the phones to resolve customer issues that aren’t readily solved—with a simple goal in mind: create a more empowered, highly skilled call-center staff, drawing graduates from top universities. As Andrew Halpert, senior director of clinical and network solutions, explains, “The typical profile is someone who majored in human biology and maybe wants to pursue a medical career, but meanwhile wants a job and to work for an interesting start-up. Then you say, ‘How are you going to keep smart people engaged and happy and not burnt out and dissatisfied?’”

Collective Health trains its hires thoroughly on key technical tools, while regularly rotating their physical locations and assigned tasks: one week they may be coordinating benefit issues, and the next solving larger issues outside their department, giving them an overall picture of how everything works. They are continually empowered to solve problems on the floor as they discover them, connecting with other teams in the company. The system has not only increased employee retention by providing people with more interesting and impactful work, it has also proven more efficient at resolving problems. Halpert says the benefits outweigh the extra costs for the company and the customer: “On the ‘how much did I pay?’ criterion, it looks more expensive. . . . The Collective Health call costs more because it’s being handled by someone who is better qualified and better paid who is also spending more time resolving the issue. But we solve problems, unlike other systems where claims and problems just go on with a life of their own.”

The Collective Health experience shows how roles can be designed both to improve people’s health and increase effectiveness for the benefit of employers—in fact, the two can be mutually reinforcing. Jobs that provide individuals more autonomy and control serve to increase their motivation, job satisfaction, and performance—while at the same time making employees healthier and helping them to live longer.

Social support

If job control is one important aspect of a healthy workplace, social support is another. Research going back to the 1970s consistently demonstrates a connection between social support and health. Having friends protects “your health as much as quitting smoking and a great deal more than exercising,” even though survey evidence suggests that the “number of Americans who say they have no close friends has roughly tripled in recent decades.”2

The evidence shows that social support—family and friends you can count on, as well as close relationships—can have a direct effect on health and buffers the effects of various psychosocial stresses, including workplace stress, that can compromise health. For instance, one review noted that “people who were less socially integrated” and “people with low levels of social support” had higher mortality rates.3

Unfortunately, workplaces sometimes have characteristics that make it harder to build relationships and provide support. Consider, for example, practices that foster internal competition such as forced curve ranking, which reduces collaboration and teamwork. In fact, anything that pits people against one another weakens social ties among employees and reduces the social support that produces healthier workplaces. Equally destructive are transactional workplace approaches in which people are seen as factors of production and where the emphasis is on trading money for work, without much emotional connection between people and their place of work.

Rooting out practices like these is a good starting point for leaders seeking to build environments with stronger social support. Also invaluable are actions such as the ones described below. These sound straightforward and are already practiced by a number of companies, but nonetheless are easy to overlook.

Demonstrate commitment to offering help

SAS Institute, often found near the top of “best places to work” lists, is a company whose business strategy is premised on long-term relationships with its customers—and its employees. The company signals in ways large and small that it cares about its employees’ well-being. For instance, when a SAS employee died in a boating accident one weekend, a question arose: What would happen to his children, currently enrolled in company-subsidized day care? How long would they be permitted to stay? The answer: as long as they wanted to and were age-eligible, regardless of the fact that they no longer had a parent employed by the company. And perhaps nothing signifies SAS’s commitment to its employees’ well-being more than its investment in a chief health officer whose job entails not just running the on-site health facility but ensuring that SAS employees can access the medical care they need to remain healthy and to be fully cared for if they get sick.

Encourage people to care for one another

The large healthcare and dialysis company DaVita created the DaVita Village Network to give employees the opportunity, through optional payroll contributions, to help each other during times of crisis—such as a natural disaster, an accident, or an illness. The company provides funding to match employee contributions of up to $250,000 per year. When southwest Florida was hit by a series of hurricanes in 2004, a dialysis administrator noted, “The DaVita Village Network provided our housing while our homes were uninhabitable, and provided funding for food until we were able to get back on our feet.”

Fix the language

People are more likely to like and help others with whom they share some sort of unit relationship, to whom they feel similar, and with whom they feel connected. Language in the workplace that emphasizes divisions between leadership and employees can further alienate people and erode any sense of shared community or identity. Ensure that people are less separated by title, and use language that is consistent with the idea of community. DaVita sometimes refers to itself as a “village.” The company’s CEO often calls himself the “mayor.” Employees are constantly referred to as “teammates” and certainly never as “workers,” a term that denotes both a somewhat lower status and also people who are distinct from the “managers” and “leaders.”

Support shared connections

Almost anything that brings people into contact in a pleasant and meaningful context—from holidays to community service to events that celebrate employee tenure or shared successes such as product launches—helps build a sense of common identity and strengthens social bonds. Southwest Airlines is famous for its Halloween parties. Other organizations offer their employees volunteer opportunities to help local nonprofits. A 2013 UnitedHealth survey found that 81 percent of employees who volunteered through their workplace “agreed that volunteering together strengthens relationships among colleagues.”

Giving people more control over their work life and providing them with social support fosters higher levels of physical and mental health. A culture of social support also reinforces for employees that they are valued, and thus helps in a company’s efforts to attract and retain people. Job control, meanwhile, has a positive impact on individual performance and is one of the most important predictors of job satisfaction and work motivation, frequently ranking as more important even than pay. Management practices that strengthen job control and social support are often overlooked but relatively straightforward—and they provide a payoff to employees and employers alike.

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