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Interview at the Motionsoft Technology Summit about Big Data

This quarter’s Business, Innovation and Entrepreneurship interview is the compilation of getting to discuss “big data” analytics with four exceptional thought leaders at the Motionsoft Technology Summit this year (2016). These four gentlemen in no particular order are: Jafar Adibi, Ph.D., the President, Co-founder, and CTO of re|unify; Jeffrey Cooper, the Senior Manager of Business Development at Samsung; Mark Newman, the President of Heads Up Analytics, and Keith Catanzano, a Partner at 2River Consulting Group. The answers below are summations of their respective answers, as such they are not represented as verbatim but edited for readability and context.


1) When a company is either building a data model (or working with a third party for this type of service), what considerations should an operator have regarding the crossroad of complexity and usability?  There are scenarios where too many disparate and incomplete data sets can make it difficult to find the signal from the noise; what are the trade-offs as the amount of available business intelligence information continues to increase? And what considerations should we take into account to maximize any investment in mining data?

[Jafar Adibi]: You need to figure out what problem you are trying to solve. Clients will come to me with data, rich sets of data, and say, “Jafar, now go figure out something to do. Find something interesting.” Generally, this is a waste of time. People believe finding correlations (any correlations) are going to help their business, but that is often not the case. When you identify your problem, we are better set up to solve it. There are different analytic methods for classification problems, association problems, and other questions that are not necessarily answered through correlative means. Getting to the right question will help you establish what data sets are important.

Then you need to figure out your budget. There will always be noise in your data, especially data from business intelligence. We can build a model to take the noise into consideration. However, using more data is obviously expensive, so that goes back to what are you trying to solve for. We can exclude data that will not answer your question, which saves you time and money. As such, you want to keep return on investment (ROI) in mind as you think about the question you are asking. Ask yourself, “If I answer this question, how much money with I gain/save?” The answer to the ROI question gives you a ballpark on what it might be worth regarding your investment in a data model.

2) It seems to me that a lot of ad hoc advice about using data for business intelligence is disseminated on broad-based assumptions derived from general population data. However, is this not one of the follies of “Big Data”? Companies are basing important decisions on arguably misleading benchmarks, rather than creating a narrative specific to their population (or at least a sample from their specific population); What are strategies to ensure we are making the best decision based on our company’s unique attributes?

[Mark Newman]: The most important thing is to trust your own expertise. You should intuitively know the customers you are trying to attract. You should have an idea of what strategies you are trying to pursue. You should already know what the important problems are you need to solve. What you don’t want to do is look to data to validate some preconceived answer to your problem. Instead, you want to devote your own educated guesses as to what to do — and then you want to use data to test those rigorously to keep yourself honest.

I think there are two ingredients to doing that. The first is to agree with your colleagues on the definitions of the terms that you are using in your data. If all the stakeholders do not agree on the definition of the numbers, then you all are not going to have an organized lexicon/narrative to work with. You have to agree on key metrics that you are going to use to allow for the monitoring of health and progress within your organization.

The second ingredient that you want to have is to follow an experimental approach that is constantly evolving. Your customers and prospects are going to react differently to your products and services over time. Reasons:

  • They might have more experience with you as your brand matures
  • As consumer groups mature, they change their goals
  • Your previous pitches are now stale, and customers react to them differently
  • Different competitors in the marketplace

What works today does not work tomorrow. Instead of some one-and-done, super solution to what you are trying to accomplish — instead you want to have some kind of innovative, incremental approach in the beginning. If you follow that, then over time, the data is going to have a narrative that reflects who you are, and what you are trying to do, and what works best for you.

3) Until recently, most data aggregation efforts have told a fairly unsophisticated narrative, and inspired relatively unremarkable initiatives in an effort to capitalize on data mining. How can we improve our use of data? And, how can companies do better at making data more actionable?

[Keith Catanzano]: What is the question the company is trying to answer? It is important to not just say, “How do you make data actionable?” We are probably all guilty at some point of looking at a data model and saying, “Look at the results, they’re awesome!” I think intriguing insights can be challenging in terms of making data actionable. There is a ton of data out there. Once you find ways to bring yours together, there is a lot you can see using data by way of insights. At some point you need to do something with the insights. In order to do that, obviously, it’s important to know who your customers are [assuming trying to influence their behavior is your goal], but also why are they customers. However, in this use case the why is more important than the who. The “why” is ultimately what you are going to try to make actionable, because to take action you are going to need to pull some type of lever to influence consumer behavior. There are lots of ways to work with communication or outreach in an attempt to accomplish this, but the effort requires the company to take a deliberate approach regarding how data is used to take action.

It is also important to note that making data actionable is generally not a one-shot deal, and architecting a campaign that changes an entire group’s behavior in some way probably will take a series of events that includes multiple levers I mentioned. So to make data more actionable, an organization should sit down and say, “What is the level of energy I want to put into solving or addressing this problem?” And that’s probably both a financial decision and a brand decision. For instance, a brand manager might ask, “Is this the kind of consumer group that we want to continue to attract? Yes; OK, well … indicators show we may be struggling with this particular group, so let’s double down because from a brand perspective, that’s how we want to be seen.” An alternative scenario here is the data suggests (to the brand manager) that too much effort is being spent focusing on the wrong group. Without asking the right questions, the data just suggests that marketing is ineffective. To finish, a company really needs shared responsibility to make data truly actionable. Ultimately, as an organization you determine what resources you want to put against data analytics, but knowing what question(s) you wanted answered first is important to making data actionable.

4) How will health club and health club member data evolve over the next several years — what will prove to be important signals for our industry in addition to financial, transactional and activity data?

[Jeffery Cooper]: So besides activity data from wearables, there will be a lot of contextual data the health clubs can now potentially get. With corporate wellness taking off you are going to see deep integration with insurance companies and insurance data. I believe, along those lines, health clubs will also be integrated more with the medical industry. As prevention becomes more associated with a basic level of fitness, I believe you will see medical data become relevant.

In that regard, I think prevention of chronic diseases is eventually going to drive a lot of people toward health clubs from the medical side of things. Right now, in most cases, doctors cannot write a prescription for a health club, but that could change as more complex sensors begin to validate the efficacy of fitness interventions.

Genomics data is another revolutionary area. You already have things like 23andMe, but there is a company Helix, which has been recently funded. Their idea is to sequence your genes, and license this data back through health care providers and fitness applications. With genomic data, consumers can make better choices (and health clubs can cater to them better). With this data, people can ask:

  • Am I suited for bodybuilding?
  • Am I suited for endurance?
  • From the limited time I have, where am I going to see the best results?

As science becomes more advanced, these companies will snapshot your genome once, and then as the science learns more and more about the genome — health clubs can take preemptive, proactive actions from that data to keep their members healthier longer, keep them out of the hospital and improve their overall quality of life.

5) Why does “Big Data” often fall short on delivering on its value promise?

[Mark Newman]: Personally, I feel that part of the problem is the way output data get reported. I feel that in data science to deliver a static report, it is potentially a sign that we have not done our job properly. The reason for that is because when we deliver a page of numbers, there is often no context to the end-user. When you are able to create/refine a business question, you generally make the presumptive problem simpler than it first appeared. Before you set off looking to get value from data, your organization should come up with your desired thresholds and metrics. Then instead of looking at static reports that, at best, will give you trailing indicators — build a dashboard that gives you real-time intelligence based on the most important metrics for your business. This dashboard should be something that your employees can always go to — not just some report that gets delivered on your desk — but something that is readily available on an ongoing basis. You also need to evaluate and monitor the efficacy of this dashboard on an ongoing basis. For instance, if you have a forecasting dashboard and there is a forecast your company is trying to meet, is the dashboard valuable and helping you meet your forecast?

I believe both dashboards that monitor things that drive your business forward, as well as insights that are actionable, are at least two things that give you some evaluation of whether “Big Data” is helpful and valuable within the context of your own particular situation. The other thing is that you really want to be doing analyses all the time. You want your data strategy to evolve past sending out graphs and numbers — to actually be working to build a story of what’s going on in your organization — and back up your story with reliable and meaningful communication so every stakeholder is seeing the same thing and you can all agree that your chosen data model(s) is providing value and is meaningful within the context of your particular business.

Interview with Dr. Henry DePhillips about Telemedicine

Dr. Henry DePhillips is the Chief Medical Officer of Teladoc. At Teladoc, Dr. DePhillips is responsible for maintaining the exceptional delivery of clinical care delivered through Teladoc’s telemedicine digital health platform. Prior to Teladoc, Dr. DePhillips held several high-level leadership positions in health care. His positions included a previous role as the Chief Medical Officer at MEDecision, working as the Senior Medical Director at Independence Blue Cross of Pennsylvania, and a role as Head of Business Development, North America for McKinsey’s international Health Systems Institute. Dr. DePhillips is a health technology fanatic who is passionate about telemedicine and shifting health care from a provider-centric model to one that better values the needs of the patient.


1) How do you see telemedicine affecting employee burnout and workplace wellness?

What I am seeing is that telemedicine provides employees quick and inexpensive access to services that contribute to their well-being. Employees also generally perceive the telemedicine experience as more enjoyable than traveling to see a physician. Employees like what we provide, so our service grows as it is better understood by employees. When people get the care they need in a timely manner, this reduces workplace wellness issues — concerns like presenteeism — because employees now have easy access to care rather than “powering through” health conditions that could have unwanted consequences if ignored.  These consequences range from getting other employees sick to compounding personal medical issues by not seeking treatment.

2) What are some of the aspects of American work culture you see uniquely contributing to issues of presenteeism and employees “powering through” illness?

There is a combination of cultural factors here in the United States. One is financial, many American employees can no longer afford to miss a day of work. A second is functional. In many U.S. companies that have downsized staff, if someone misses work then there is no longer anyone to cover their role/position — calling in sick is simply not an option. A third is cultural considerations. In America it is a sign of toughness and/or commitment if an employee powers through their illness. For instance, it can be viewed as a “badge of courage” if you come in with the flu. Lastly, there are logistical considerations. In many cases when someone should see a doctor, they are unable to do so because scheduling is difficult given other considerations. This last factor is where I see services like Teladoc playing an important role. With telemedicine it is no longer a burden to see a doctor. With the traditional approach you generally must take time off work, schedule an appointment, travel from work to see your physician. Now, if an employee is in need of care, it is as close as their keyboard or mobile phone. An experience that used to be three to four hours can now be accomplished in 30 minutes with telemedicine — and unless you need to pick up a prescription, your experience can all take place in a virtual environment of your choosing.

3) How do you see telemedicine playing a role in helping improve the patient experience?

With Teladoc you can update your electronic medical record in minutes, request a board-certified physician to meet with you at a time that works with your schedule, interact with your physician using the digital modality of your choice (phone, video conferencing, digital photos, etc.), and have prescriptions sent to a location that is convenient for you. In my opinion, it is simply a better experience.

4) There are reports that over 15 million people now use telehealth, which is a 50 percent increase in usage from numbers reported in 2013. Who is driving this growth?

Telemedicine is still perceived as a rather new way of receiving care, so we have plenty of early adopters (now) but you are going to see increased utilization blossom as we move into the early majority. Those that would rather take a conservative/traditional approach will likely become more open to telemedicine as the technology matures. “Try it once, and you will like it for life,” really applies to our technology. We see that once users try it once they often return, at least here at Teladoc. In certain populations it is a no brainer — single parents with kids, those that travel for business — again anyone with logistical considerations will likely become lifelong users once they try it once.

5) Why do you think there is a significant proportion of physicians that have an aversion to telemedicine?

It is an evolution. It is a work in progress. Health care as an industry tends to be fairly conservative when it comes to technology. Think back to the Marcus Welby, M.D. days and we have not evolved much since then in regards to care. Health care is still a very provider-centric experience. The provider tells you the times that work for them, you go to the provider’s place of practice, the provider basically makes you adhere to what is convenient for the provider. I see telemedicine as the first major shift towards a consumer-centric approach. Under the current antiquated paradigm, a patient has to say, “I am sick, where must I go to receive care?” However, with telemedicine the patient can now ask, “I am sick, how can I most efficiently get the care I need?” And now, care is as close as the smartphone sitting on the bed stand. The doctor now comes to you, at a time convenient for you. At Teladoc, the average time between requesting a visit and being able to see a physician is 10 minutes. My job as the CMO of Teladoc is to make sure that the quality of care that people expect [from the old model] is the best it possibly can be [in the new model] as we go through this evolution. It is important to note, telemedicine is meant to address a subset of medical problems that has been specifically selected to work with telecare, problems that can be accurately and successfully treated using this form. In most cases I believe telemedicine will provide the end-user a superior experience, but there are going to be some specialties where telemedicine doesn’t make sense, and that is okay too.

Live Life Love | Volume Thirty-Six

Hi Everyone,

So this was not the way I wanted to start the next chapter. As many of you know — and I regretfully inform those who do not — my brother Brian passed away sometime within 24 hours of my hitting send on the previous Live Life Love newsletter. A surreal coincidence to know that as I reported to you how much I enjoyed the experience that he and I had shared, there would never be an opportunity to share another experience with him again. As you might expect, Brian’s death has led to some pretty deep introspection the past few months. As a result, this is a difficult newsletter to write this quarter. The words are not flowing. I could try to end with some catchy quote about life and/or death, but that would be the easy route. The experience has opened an uninvited path to some deep work on my thoughts about the meaning of contribution and legacy. I hope to evolve this “project” into something much bigger than a personal platform. However, for this particular installment I have to go back to basics, which is just remembering to breathe.

Business, Innovation and Entrepreneurship: This quarter’s interview is a compilation about “big data” analytics with four exceptional thought leaders: Jafar Adibi, Ph.D., the President, Co-founder, and CTO of re|unify; Jeffrey Cooper, the Senior Manager of Business Development at Samsung; Mark Newman, the President of Heads Up Analytics; and Keith Catanzano, a Partner at 2River Consulting Group. My collaborative interview focusing on business issues involving “big data” can be read here.

Health and Wellness: My health and wellness interview this quarter is with Dr. Henry DePhillips, who is the Chief Medical Officer of Teladoc. Prior to Teladoc, Dr. DePhillips was the Chief Medical Officer at MEDecision. He also previously served as the Head of Business Development for McKinsey’s international Health Systems Institute, as well as served as Sr. Medical Director at Independence Blue Cross of Pennsylvania. My interview with Dr. DePhillips about telemedicine and telehealth can be read by clicking here.

Life Experience: This quarter I traveled to Baltimore, Maryland, and checked out the American Visionary Art Museum. The museum showcases art from artists who are primarily self-taught. As such, much of the art and installations revealed the personal vision of the artist, rather than following standard conventions.

American Visionary Art Museum | Baltimore, Maryland
American Visionary Art Museum | Baltimore, Maryland

Contribution: My friend Alex lost his wife Samantha to cancer on November 1, 2013. She was a free spirit and certainly would be at home at the American Visionary Art Museum. When she passed, she left behind an unfinished album of songs, and it was bittersweet to be part of a Kickstarter campaign to get it finished. If you would like to learn more about it, or potentially contribute yourself, you can do so by clicking here.

I would like to conclude by simply saying thank you to the many of you that reached out to me and/or my family these past few months. The warmth that was bestowed upon us was overwhelming and helped us tremendously navigate through this difficult time. I love my brother very much, and take solace that his spirit will be interwoven into this effort as I continue forward. Borrowing from his humility and sense of adventure, I will do my best to increase the utility of information this project provides, as well as seek out new experiences that are worthy of sharing — carrying his memory with me.

In health,
Dr. Rucker

P.S. Again, for those of you that knew Brian, my hope is that this is not the medium you are finding out about his passing. Brian’s obituary is available online here.

Live Life Love | Volume Thirty-Five

Hi Everyone,

Roy Amara, a systems engineer who worked at the Stanford Research Institute, is credited for establishing Amara’s Law: We tend to overestimate the effect of a technology in the short run, and underestimate the effect in the long run. This sentiment has now been repackaged by many in motivational and coaching occupations and repurposed to serve as a testament of our inability to accurately estimate human effort. Back in March 2011, I indicated it was the beginning of a new chapter. Today, six years later, I am grateful to share that chapter is closed. The starting line was no job, no kids and an ambitious goal. The finish line is a Ph.D., two healthy kids and recently being honored as one of the top 50 influencers in digital health. Unfortunately, there is no secret sauce to share. Advice from Gary V. and Grant Cardone failed me. Instead, I found diligently and constantly working smarter was better (for me, at least) than trying to work harder. I truly respect those that hustle, but in the final analysis of this “chapter,” when I gunned it looking for short-term wins I consistently fell flat (maybe why I have always been terrible at sales). This long play, though — pretty happy with the end result.

Business, Innovation and Entrepreneurship: This quarter’s interview is with John Gengarella. John is a Harvard graduate, well-known for customer-centric design and application development. In 2015, John was appointed the CEO of Netpulse, one of the market leaders in mobile technology for the fitness industry. My interview with John focusing on the business of fitness technology can be read here.

Health and Wellness: My interview around health and wellness this quarter is with Jill Gilbert. Jill is a lifelong entrepreneur. She created the first comprehensive online directory and resource for senior care, Gilbert Guide. Jill also produces the Digital Health Summit at CES, as well as several other prominent digital health events year round. My interview with Jill about health technology can be read by clicking here.

Life Experience: I traveled to Jackson, New Jersey, to log this quarter’s life experience, which was to ride the largest roller coaster in the world, the Kingda Ka. Reaching a height of 456 feet, there is not a taller roller coaster in existence. I got to enjoy the experience with my brother, which made it even better.

Kingda Ka roller coaster

Contribution: Some great opportunities to log contribution this quarter, which is always gratifying. I was a benefactor for the following charities: Dare to Bare, Cystic Fibrosis Foundation and March for Babies.

If you feel like contributing this week, here is a good deed that will not cost you a thing. One of my neighbors here in Alameda, Dan Goldfield, is extremely passionate and selfless about helping others. He teaches at-risk youth and is trying to get a small grant from Farmers Insurance to take his students to the Point Reyes National Seashore. If this is something you can get behind, please think about supporting him with a vote by clicking here (you need to search Alameda, CA, for his name to come up). You can vote once every day for the next week.

Wishing you a very prosperous summer. Reach out if you are up for a burrito and/or a beer. I have a little more time for either/both than I have had the past few years and I’m really looking forward to the next chapter. Hope to see you in it.

In health,
Dr. Rucker

Interview with John Gengarella about Fitness Technology

John Gengarella is known for his extensive experience in global operations, customer-centric design and application development. He has been connected with highly successful enterprise software businesses for over 25 years. However, John began his career in the fitness industry. Outside of the fitness industry, John has held executive roles including vice president of C3 Energy, Chief Revenue Officer for 24/7 Customer and CEO of Voxify. In 2015, John was appointed the CEO of Netpulse, a company that has been viewed as one of the market leaders in mobile technology for the fitness industry. In addition to his professional work, John is the lead mentor in the non-profit organization StartX, which focuses on the development of Stanford’s top entrepreneurs through experiential education. He is also an angel investor and advisor to various early stage technology ventures.


1) One thing that consistently surprises me is that it usually takes a while for emerging tech companies — ones that specifically focus on health clubs — to realize that the total addressable market (TAM) regarding health clubs is actually fairly modest. In this regard, what lessons can you pass down to anyone thinking about creating technology that caters to health clubs?

I do not agree that it is a small total addressable market. I actually believe it’s enormous.  I think if you look at what’s out there today, you’ve got a handful of groups doing over a billion dollars in sales. If you look at the spend over the entire industry, there are testaments of over a $70 billion TAM. Folks are investing serious money to engage their members. I believe there are 185,000 clubs globally, that’s an enormous market. MINDBODY got a $450 million evaluation, a company that’s focusing on a niche segment of the market — studios.

You can easily build a $100 million company in this space. But it depends on how you define the market. Thirty years ago or so, I had a few clubs. We had index cards that had member’s names on them and you stuffed envelopes with monthly invoices that looked like the things you get at Denny’s. So, if you were assessing the fitness market at that time as an entrepreneur, did you say, “Hey, I’m going to make money on index cards and envelopes,” or did you say, “Hey, I can build a CRM solution, or automated billing system, and completely change the dynamics in a new set of investments in that segment?” I think you have got to look at the market overall and how we’re solving problems. I think if you look at IT spend, for example, that might be a small number. That might only be a billion dollars. But what does an average club spend on marketing? It’s 10x that spend. I bet worldwide clubs spend close to 10 billion annually on member acquisition. I think there is an enormous opportunity for the right entrepreneur in this space. The challenge is you have to go solve a problem. What do I do to engage members? What do I do to attract new members? What do I do to increase my retention? …the same core tenets exist from 30 years ago.

So my assessment is I think the market’s huge. And then, where do you draw the line? Is it Fitbit? Is it Under Armour? I mean the lines are blurring every day, there are tens of billions invested annually in fitness. As a software guy, I’m not as interested in treadmills and those kind of things. The Precors and the Matrixes will make their money selling equipment. 30 years ago, we talked about what was inside our four walls. Today, now we are talking about engagement with members outside of those four walls, as well. The club brand is still alive and well… on your app… on your T-shirt — but the market is changing. It is no longer necessarily simply what is happening in those three hours a week inside the club anymore.

2) As the head of a company that makes a great fitness mobile app — specifically regarding fitness — what is the role of activity trackers as they exist today, when the modern smartphone often rivals the internal hardware of commercial fitness devices?

That’s interesting. There is no question that the Apples and the Samsungs are going to be battling the Fitbits of the world very soon in terms of tracking. You have a few pieces that you’re solving for in this space:

  1. You need a form factor that works
  2. You want as complete of a data set as possible
  3. You want accuracy

I think the biggest challenge for smartphones is form factor. Especially since phones are getting bigger as they also are turning into mini entertainment centers. Also, women often leave their phone in their purse, so it is not constantly tracking activity. I think form factor is a challenge for phones today. What this means is you are also not getting a complete data set. For those who want all their activity tracked, you need to have your phone glued to you 24/7. Accuracy is also an issue. Without separate peripherals you are not going to get heartrate information, at least not accurately. There is still skepticism, even if smartwatches take, that they can accurately track heartrate. 

Phones do have a phenomenal advantage in that they are ubiquitous, and adoption is exceptional. I don’t know anybody that does not have a smartphone today. But what do I get out of that? Do I get the accuracy of my heart rate? Do I get other capabilities that I want to see… capabilities I can get from a wearable that I am in touch with the entire time. Given what we are trying to solve for, it will prove to be an interesting battle.

3) Looking past current wearables on the market today, where do you see digital health taking the health club industry five years from now?

That’s a really interesting question because the potential has become enormous, but just as it has been for the last 30 years, the next five will still be about relationships. What’s the relationship that I have today with my club (as a member)? What’s the relationship that I have with the other members? What’s the relationship that I have with my employer? What’s the relationship I have with my healthcare provider? My doctor? My coach? My team? I think when you look at the evolving way we engage in relationships through technology, you’ll see the digital aspect of that becoming more pervasive. I am not addressing just the customer relations concerns here, but also the relationship an employee has with their employer —  a financial relationship that plays a role in the person’s well-being. The big challenge is going to be the exchange of value. To me, there is a two-way value exchange. For instance, I (employee) let you see my steps on a daily basis, you (employer) give me $300 towards my monthly insurance bill. People love to discuss privacy concerns, but quickly forget it was only a few years ago they were hesitant to store credit card information with Amazon.com. Privacy issues aside, annual healthcare spend is the largest line item on our country’s P & L! Follow the money — over the next five years there will be enormous energy around a digital understanding of each consumer, each member, each employee. I see this evolving into some greater level of personalization that simply does not exist today. How do I get to know a specific person in a meaningful way and understand their needs, provide them value for that exchange, and capitalize on the value associated with that understanding in an ethical way? We’ll answer that question.

4) There is a modern-day narrative that fitness delivery is well-positioned, better than ever, to be on the forefront of the continuum of health care. However, this discussion has been going on for a few years now (e.g. Exercise is Medicine, Exercise is a Vital Sign, etc). In your opinion, do you believe technology has helped, or hindered, progress in this area? 

The challenge is the complexity around data privacy. What are the responsibilities around those that are in charge of the data? How do I protect the consumers’ willingness to share? What level of privacy should I expect in terms of dealing with any manufactured insight, i.e. new personal information generated about me that could effect my livelihood (e.g. credit score)? This problem doesn’t get solved with one “ah-ha” moment. There are going to be step-changes that go along with this because we are a cautious nation when it comes to privacy. There are credit card breaches all the time with little consequence. But, if I let somebody know what your blood pressure is, I can still go to jail. So, I think that we are cautious as a society about health data, but I believe you will see that loosen over time. What are the true risks if I share this information? Truth is, you probably have a great interaction with your doctor and she becomes wonderfully more insightful about your health.

There are valid, historic concerns about the consequences of having a preexisting condition. There’s a scare about how that data can be used and possible negative impacts that could come as a result of someone having that information. Again, fair value exchange becomes important. I’m willing to share, if there is limited risk and I get something in return. Few are going to share data for the fun of it. If people get better care, get a lower rate on insurance, get more personalized programs that are really consistent with their health, they will come around. You can see that today, in the volume of opt-in consumer apps that are out in the market. There will be dissection among the population: those that are willing to share health data and those that are not. There is always a sub-segment that’s going to believe in some conspiracy theory that, “data will always be used against me.” They are not going to participate willingly. Luckily there are many that have a willingness to take that risk. I think the more challenging issues are not around, “Can I collect data and generate insights around this woman’s health and well-being?” The challenges are more going to be around policies and protections that allow the consumers of that information to use it appropriately and ethically. To me it’s not technology that has hindered us so much… people have.  

5) The last couple of questions I have asked you what you think might be different in the future regarding fitness technology, a harder question might be the one I will conclude with: what is going to remain the same five years from now?

Five years from now, mobile will still be the center of our lives. It is the communication mechanism for any audience, whether you are talking about a health club member, you are a member of an airline, a hotel guest, or an Uber rider. Mobile will remain the primary platform for customer interaction in the near future. This bears repeating from my previous answer… thirty years ago, I used to have a few health clubs and the same mandates exist today: a need to acquire new members, a need to retain those members, and a desire to increase the contribution/benefit made to the member base. That’ll be the same in five years… probably for as long as health clubs exist.

With the pervasiveness of availability of information available to the consumer, the fitness industry, like any other mature industry, is becoming more and more competitive. So, the drivers of asset performance will be the same in five years. Mechanisms for personalization will evolve. There will be this quest for personalization. Whether I have a big box or a small box, I will be able to use technology to have the capability to differentiate my offering with personalization, but that is only filling the need that has always been there …building a meaningful connection with your member. 

Interview with Jill Gilbert about Health Technology

Jill Gilbert is a lifelong entrepreneur and the producer of the Digital Health Summit. Jill worked in the film industry for 15 years before moving on to health and technology. After leaving Los Angeles, her initial focus was the crossroads of aging and technology. She created the first comprehensive online directory and resource for senior care, the Gilbert Guide, for which she was praised as the champion of positive change in the aging services industry. In 2015, she launched another event at CES, Robots on the Runway, which focuses on the world of robotics. Her latest project is called Discover Baby Tech, a website and blog that will aim to bring together products and technology for new parents.


1) Behavior change and wearables are two buzz terms often talked about in the same conversation, yet many devices don’t truly deliver on the promise of actively helping someone change their behavior. What’s a favorite example of a digital health product that actively assists the user in building a desired habit?

Activity trackers have become synonymous with the word “wearables.” These devices (activity trackers) will certainly change some people’s behavior, primarily through awareness. Oftentimes, though, they fall short when it comes to behavior change. I’m more excited about closed-loop wearables, devices that are often condition-specific that trigger — or better yet, assist — with the desired next action to treat a particular condition. When you can engineer the need for “change” out of the usage loop, you immediately get a lift with regards to device efficacy. Most behavior change — when it comes to wearables — is going to be as good as the prompt and/or stimulus. The closer we can get the stimulus to inspire (or be) the next desired action in the loop, the closer we get to behavior change being a non-factor. Until activity trackers move our feet for us, I believe they won’t be as successful as other innovations I have seen recently in digital health.

2) It’s clear that the industry is on the verge of some significant breakthroughs. In your opinion, what’s currently being underreported regarding health technology that deserves greater attention?

Mental health is an area where digital health really can play an important role. For instance, pharmaceutical adherence is a huge issue in mental health. Many people with mental health issues suffer when they are not regimented about taking their medication. We are also making strides with regards to digital therapeutics. Cost is a major factor in treating mental health, and advances in the way we can treat people through behavioral modification platforms that are scalable — made possible because of digital health — is exciting. Telemedicine is also making an impact, by allowing patients to benefit from doctors that have excess capacity. Health technology is allowing people to get treatment who are so unwell they cannot leave the house. It is opening up treatment options for those worried about stigma. There are a lot of great things happening here, but it is not getting as much attention as one would think. Look what Lantern is doing, look what Iodine is doing, this is great stuff and not talked about enough. There is also a lot of promising technology to help with addiction as well.

3) Digital health is well-positioned as a valuable tool to help people with their entire continuum of care, with the potential of assisting people in lessening the frequency of doctor visits. What needs to happen so that consumers can have a better coalesced health experience through digital technology?

Interoperability is key. It is so important, and its lack of existence creates so much friction. Because the problem is so complex, we see people design around it (data operability), and what you are left with is disparate solutions. Literally, digital health in a lot of ways is the Wild, Wild West. Yet, on the other side you have hospital systems with antiquated legacy systems that often don’t even have APIs. We are finally making some strides though… Cisco and UCSF have partnered to engineer an integrated health platform that will hopefully get us closer, but the problem is mammoth. We need smart minds and a lot of resources to solve this problem.

4) Technology is inherently always changing. That said, what have been the constants since 2010 that are facets and/or indicators of successful digital health products? In other words, what is foundational for innovators to get right, or avoid getting wrong, in order to be successful in this space?

This sort of piggybacks off my Wild, Wild West comment. This space is inherently complex, and so in a lot of cases processes that work for pure tech start-ups — like creating a minimal viable product (MVP) — fail in this space. Especially if you hope to get FDA approval, there is a lot to navigate and that’s why we always stress strong partnerships. That said, companies still need to be bold. True innovation and breakthroughs come from mavericks who accomplish what others say cannot be done. There is a balance. The good news for innovators is that it is hard for bigger companies to take risks, so often through the “right” type of partnerships a start-up can get significant help from a larger organization. Obviously, there will be unique considerations that depend on the product. A reimbursable product is probably going to have to rely more on outside help than a consumer box product. The good news is there are great partners out there, like Ximedica, whose primary purpose is to help these types of products figure out a proper strategic path and wade through the intricacies of regulation.

5) You have set your sights on baby tech. Why baby tech? And what benefits do you hope to deliver with this next endeavor?

My ideas around baby tech came about from CES, and getting a lot of products sent my way that were meant for babies, new moms, fertility, post-pregnancy, etc. There was/are enough interesting digital baby products out there, and it was clear this is a distinct category worth addressing. Also, I got enthusiastic about it because I was about to become a new mom myself when I first saw this category get exciting. There is so much amazing stuff out there. Moms can go it alone, we have for decades, but [digital products] might help ease some of the burdens. I am creating DiscoverBabyTech.com to share what I know, create a space for product reviews, report new developments in this space and generally create a resource for moms interested in this topic. The plan is to launch next month sometime. We hope to attract people like ourselves to the site, new moms who love tech.

The Interesting History of Workplace Wellness

The Interesting History of Workplace Wellness

The history of workplace wellness starts with the Italian physician Bernardini Ramazzini (1633-1714) who is believed to be one of the first to write about the effects of work exposure on workers (occupational diseases) and was interested in the possibilities of taking preventative measures (Gainer, 2008) to help improve employee well-being. Half a century after Ramazzini’s death, the Industrial Revolution brought with it many new health problems and injuries due to the way work was reformulated and systematized.

In 1810, Welsh social reformer Robert Marcus Owen proposed a 10-hour work day to help protect the well-being of workforces. By 1817, he purposed a more aggressive measure — the 8-hour work day — and coined the phrase “eight hours labor, eight hours recreation, eight hours rest” (Donnachie, 2000). One of the first organizations to implement Owen’s ideal on a wide scale in the United States was the Ford Motor Company in 1914 ([Ford] Gives $10,000,000, 1914; Chalmers, 2013).

In 1832, Charles Turner Thackrah is credited for having created the first written account of the health problems of industrial workers (Gainer, 2008). Accordingly, Thackrah’s book is considered a pioneering work in the pursuit of improving employee well-being. In his book Thackrah wrote, “The evil of the employ is the incidental one of intemperance (Thackrah, 1832, p.18).” In context, I believe this quote from Thackrah is likely highlighting that employers often operate their organizations with disregard for moderating or restraining their employees’ working conditions.

These notable milestones notwithstanding, workplace wellness was generally an afterthought for organizations up until the advent of Employee Assistance Programs (EAPs) in the 1950s, when companies began to offer wellness interventions primarily focused on alcoholism and mental health issues (Owens, 2006). According to Reardon (1998), true workplace wellness programs did not really begin to exist until the mid-1970s. During this timeframe, there was a perceived shift in financial responsibility for health care, from government to employer. The development of worksite wellness was motivated primarily by cost containment (Reardon, 1998). It was also linked with the activities of the occupational safety and health movement (OSH) and the worksite health promotion movement (WHP), which developed in the late 1970s (DeJoy & Southern, 1993). Greiner (1987) cites the following reasons behind the emergence of worksite wellness during this period:

  • A general culture shift that promoted fitness
  • Emerging research findings that showed the cost of employees’ unhealthy habits
  • Newly formed workplace health promotion groups such as the Washington Business Group on Health and the Wellness Councils of America.

Furthermore, in 1974, the Employee Retirement Income Security Act (ERISA) was established, which was a further signal of the increased concern for employee health. It set the minimum standards for most voluntarily established pension and health care plans in private industry to provide protection for the individuals in these plans (Call, Gerdes, & Robinson, 2009).

The Johnson & Johnson’s Live for Life program, which became known as the prototype for big corporate worksite wellness programs, was started in 1979. The program included a questionnaire and a physical assessment with the purpose of collecting information on each person’s activity levels and body fat measurements. The company then provided support to control risk behaviors — weight control, nutrition, and stress management (Pencak, 1991). 

In 1980, with the arrival of a new political administration in the United States, health promotion focus was lost at the federal level (Greiner, 1987). However, workplace wellness programs began appearing in academic literature in the early 1980s. The articles of this time were mainly discussions of the effects of physical fitness efforts on workers’ health and performance (Call, Gerdes, & Robinson, 2009). In 1982, the Journal of Occupational Health started featuring articles that looked at how workplace wellness programs could reduce absenteeism and other costs related to illness, as well as a few articles that discussed how fitness centers could potentially attract top talent (Call, Gerdes, & Robinson, 2009).

Outside EAPs, workplace wellness programs in the United States during the 1980s seem to have primarily focused on the physical aspect of health, while ignoring other health dimensions. In the late 1980s, companies started addressing issues of psychological well-being as part of a more encompassing workplace wellness strategy. In 1986, the OSH started an initiative that emphasized workers’ mental health. Its aim was addressing the issue of work-related mental health disorders (mainly focused on stress-related illness). This was followed in 1991 with another initiative, Managing Depression in the Workplace, which was launched by The National Institute of Mental Health (Reardon, 1998).

In the 1990s, the federal government launched an initiative called Healthy People 2000 that proposed that 75% of employers with 50 or more workers should offer health promotion services as a benefit (Reardon, 1998). The evidence for the advantages of worksite wellness was scarce; nonetheless, the belief that workplace health promotion brings benefits to a company by having a positive impact on employees was becoming a popular concept among managers who started supporting such programs more widely (Pencak, 1991). During this period, wellness and health promotion programs were generally divided into three levels (Pencak, 1991):

  1. Level one addressed awareness (e.g. classes, posters, health fairs)
  2. Level two was concerned with lifestyle and behavioral change (education to support habit change — these programs generally lasted up to 12 weeks)
  3. Level three targeted the environment (these programs had no time limit and encouraged the work environment to support the changes through organizational structure and increased knowledge)

In 1994, The National Survey of Worksite Health Promotion Activities found that 80% of enterprises were offering educational activities to raise their employees’ health awareness, 44% had facilities for fitness and were encouraging activities, and 30% were doing HRAs of their employees (Reardon, 1998). In 1996, Pender’s Health Promotion Model provided guidance for the development of worksite wellness programs (Reardon, 1998). The Pender Model adopted a holistic view of an individual and went beyond the physical dimension of health. It targeted reversible behaviors and gave organizations a framework to work with.

In 2000, the U.S. Department of Health and Human Services published a new version of the program Healthy People 2000Healthy People 2010. The new program had a similar goal to its predecessor: it aimed for 75% of worksites with 50 or more employees to have a comprehensive health promotion plan (Hughes, Patrick, Hannon, Harris, & Ghosh, 2011) consisting of 5 key elements: (a) health education, (b) supportive social and physical work environment, (c) integration of the program into the administrative structure, (d) related programs (e.g. assistance for workers), and (e) screening programs.

Over the past fifteen years, workplace wellness programs have seemingly taken off. These programs have moved from providing health information, counseling, and fitness delivery to using monetary rewards to incentivize employees to stay well (Wieczner, 2013). In particular, the United States has made significant strides toward ensuring the well-being of employees. With this increase in exposure, there has been an increase in attention paid by big businesses to the efficacy and cost-effectiveness of wellness programs, yet very little research exists for small and mid-sized business. Unfortunately, much of the data from large-sized organizations regarding workplace wellness cannot be generalized to SMBs due to SMBs’ smaller budgets, different business strategies and different employee considerations (Hughes, Patrick, Hannon, Harris, & Ghosh, 2011). Furthermore, barriers still exist with SMBs to be able to offer these types of programs at scale. Small companies seem particularly challenged in offering wellness programs (McPeck, Ryan, & Chapman, 2009). According to one study, less than 7% of small businesses offer wellness programs (Carter, Gaskins, & Shaw, 2005). Hughes, Patrick, Hannon, Harris and Ghosh (2011) describe several factors that hinder health promotion programs in small and mid-sized companies. First, there is the additional cost such programs impose on a company that might already be financially overburdened. Mandatory health and safety regulations generally take priority over voluntary health promotion programs, and as such any ideas of participatory workplace wellness programs fall by the wayside. Small companies often lack a health and safety department, which tends to be the initiator of workplace wellness programs in many larger companies. Another factor is that small companies might not offer health insurance and employee benefits that would often be the motivation for preventative programs (Hughes, Patrick, Hannon, Harris, & Ghosh, 2011). Burke (2006) also suggests that there is generally a lack of awareness and understanding about worksite wellness in smaller companies.

There are, however, other characteristics that perhaps make wellness programs in small companies easier to deploy than they would be in large corporations. These include reduced bureaucratic demands, which give easier access to health promotion vendors; better connections between the management and workers, easier communication and, possibly, more empathy towards workers who are seen as “a part of the family” (Divine, 2005).

Little, if any, research has been done on the topic of the decision-making process in relation to the adoption of wellness programs in SMBs (Hughes, Patrick, Hannon, Harris, & Ghosh, 2011). Hughes, Patrick, Hannon, Harris, and Ghosh (2011) conducted a qualitative study that explored some of the factors (structural, cultural, work factors) that support the development of wellness programs in small and mid-sized companies. The participants in the study stated that they rely on brokers or health insurers for health promotion education. The main criterion for a SMB adopting a wellness program was its cost and cost-effectiveness (program cost-benefit). The employers in that study expressed that they desire information on the cost-effectiveness of the program, as well as data showing that the programs will bring the benefits they sought (e.g. reduced absenteeism). Simply summarized, high program cost and low program cost-benefit may be barriers to adopting these programs with SMBs. Employers in the study considered both direct and indirect costs (such as the cost associated with employees taking time off work to participate in the program).

According to Hughes, Patrick, Hannon, Harris and Ghosh (2011) there are three key tactics that need to be considered when working with SMBs:

  1. Health promotion needs to be related to overall company success-related factors (usually financial success). Some of these factors include employee productivity, recruitment, and retention. These factors are more convincing to small businesses than the actual quantifiable health care cost savings.
  2. Insurers and benefits brokers should be the potential channel for expanding health promotion.
  3. Senior management and human resources should be the targets. The members of senior management are often the final decision makers, so they need to be presented with the relevant health promotion information.

More research is required on the subject of optimal design and funding of health promotion and preventive care benefits for small to mid-sized businesses. There is a lack of knowledge of the impact of workplace health promotion on small to mid-sized businesses’ bottom line, employee retention rates, and productivity levels (Hughes, Patrick, Hannon, Harris, & Ghosh, 2011). These findings need to be conveyed to insurers, brokers, and workplace health promotion vendors and could help build the business case for worksite wellness programs.

It is important to note at least one study contradicts the findings of Hughes, Patrick, Hannon, Harris, and Ghosh (2011). Divine (2005) found that humanitarian reasons and employee-relation goals prevail over financial motives when trying to inspire SMBs to take up workplace wellness. Putting aside a SMB’s motives for workplace wellness, the available literature does generally support that SMBs rely on benefits brokers and health insurers for wellness solutions (Marquis and Long, 2000). A national study by Marquis and Long (2000) supports the assertion that SMBs generally use outside experts to pick their programs. Studies by McPeck, Ryan, and Chapman (2009) and Goetzel and Ozminkowski (2008) also support the reliance on outside vendors and the role of senior management.

Sources:

Burke, B. (2006). Public policy options for small employer health insurance. North Carolina Medical Journal, 67(3), 222–224.
Call, C., Gerdes, R., & Robinson, K. (2009). Health and wellness research study: Corporate and worksite wellness programs: A research review focused on individuals with disabilities (Government Contract Number: DOLU089428186). Gaithersburg, MD: Social Dynamics, LLC. Retrieved from http://www.dol.gov/odep/research/CorporateWellnessResearchLiteratureReview.pdf
Carter, M., Gaskins, S., & Shaw, L. (2005). Employee wellness program in a small rural industry: Employee evaluation. AAOHN Journal, 53(6), 244–248.
Chalmers, W. D. (2013). America’s vacation deficit disorder: Who stole your vacation? Bloomington, IN: iUniverse.
Chapman, L. (2004). Expert opinions on “best practices” in worksite health promotion (WHP). American Journal of Health Promotion, 18(6), 1–6.
DeJoy, M., & Southern, J. (1993). An integrative perspective on worksite health promotion. Journal of Occupational Medicine, 35(12), 1221–1229.
Divine, R. L. (2005). Determinants of small business interest in offering a wellness program to their employees. Health Marketing Quarterly, 22(3), 43–58.
Donnachie, I. (2000). Robert Owen: Owen of New Lanark and New Harmony. Edinburgh: Tuckwell Press.
[Ford] gives $10,000,000 to 26,000 employees. (1914, January 5). The New York Times. Retrieved from http://www.nytimes.com/learning/general/onthisday/big/0105.html
Gainer, R. D. (2008). History of ergonomics and occupational therapy. Work, 31(1), 5–9.
Goetzel, R. Z., & Ozminkowski, R. J. (2008). The health and cost benefits of work site health-promotion programs. Annual Review of Public Health, 29, 303–323.
Greiner, P. (1987). Nursing and worksite wellness: Missing the boat. Holistic Nursing Practice, 2(1), 53–60.
Hughes, M. C., Patrick, D. L., Hannon, P. A., Harris, J. R., & Ghosh, D. L. (2011). Understanding the decision-making process for health promotion programming at small to midsized businesses. Health Promotion Practice, 12(4), 512. doi:10.1177/1524839909349162
Marquis, M. S., & Long, S. H. (2000). Who helps employers design their health insurance benefits? Health Affairs, 19, 133–138.
McPeck, W., Ryan, M., & Chapman, L. S. (2009). Bringing wellness to the small employer. American Journal of Health Promotion, 23(5), 1–10.
Owens, D. M. (2006). EAPs for a diverse world: Employers that provide culturally competent employee assistance programs show employees they care. HR Magazine, 51(10), 91–96.
Pencak, M. (1991). Workplace health promotion programs: An overview. The Nursing Clinics of North America, 26(1), 233–240.
Reardon, J. (1998). The history and impact of worksite wellness. Nursing Economics, 16(3), 117–121.
Thackrah, C. T. (1832). The effects of the principal arts, trades, and professions, and of civic states and habits of living, on health and longevity: With a particular reference to the trades and manufacturers of Leeds, and suggestions for the removal of many of the agents, which produce diseases, and shorten the duration of life. From the London ed., with improvements. London: Porter.
Wieczner J. (2013, April 8). Your company wants to make you healthy. The Wall Street Journal. Retrieved from http://www.wsj.com/articles/SB10001424127887323393304578360252284151378

Live Life Love | Volume Thirty-Four

Hi Everyone,

I hope 2016 has been amazing for you so far. If you wanted to make a change this year, New Year’s resolution or otherwise, and your motivation has slipped to the point that progress has stalled, remember this: when we engage in any behavior, motivation is only half of it. The other half is ability. Motivation is easy to stimulate, but — unfortunately for many — hard to maintain. Ability is our capacity to engage in a particular behavior. Ability is not simply skill, but the overall ease at which the behavior can be performed. So if you are feeling stuck, and motivation is not doing it for you, try making your path to success easier. We all have a limited capacity to pump ourselves up, but through a host of creative strategies we can almost always increase our ability to perform a desired behavior. This can be done through environmental changes. For instance, if I want to eat healthier meals I can stock my house with only healthy foods (thereby increasing my ability to eat healthy). Or, if I want to run a marathon I can start with achieving a 5 or 10 kilometer race until I build up the needed skill/mastery to achieve a marathon (reengineering the goal to match my current ability). Toying with the ability variable (in the Fogg Behavior Model) is often overlooked because it is goal/behavior specific and motivation is sexier and easier to sell. The good news is when motivation begins to fail us we still have other tools to stack the deck in our favor.

Business, Innovation and Entrepreneurship: The interview this quarter is with Dr. Edgar Schein who is one of the most prominent organizational development figureheads alive. He earned his Ph.D. in social psychology from Harvard University and later went on to teach at MIT. Dr. Schein is considered one of the godfathers of organizational culture. My interview with Dr. Edgar Schein centered around organizational culture is available by clicking here.

Health and Wellness: This quarter’s health and wellness interview is with Dr. Mitesh Patel who is well known for his research on behavioral economics, where he and his colleagues are discovering innovative ways to elicit and improve healthy behavior. Dr. Patel has been featured on NPR, CNN and in The New York Times. Click here to read my interview with Dr. Mitesh Patel about using rewards and incentives to elicit behavior change and improve health.

Life Experience: Orlando, Florida, was the stage for this quarter’s life experience(s). I spent several days exploring International Drive, which is full of interesting things to see and do. I made my way to the Orlando Eye and WonderWorks (pictured) which is an exploratory museum where the exterior has been built to look like the entire building is upside-down.

WonderWorks | Orlando, Florida

Contribution: For contribution this quarter, it was my pleasure to start the year’s philanthropic efforts by donating to AIDS/LifeCycle 2016 on behalf of Justin, as well as making another donation to Augie’s Quest in support of ALS research.

This newsletter marks entry into the second third of the Live Life Love Project. Moving into next quarter, I find myself on mile 25 of my doctoral marathon. By the time I publish next quarter’s edition I’ll have a doctorate. If a 43-year-old hack like myself can get a Ph.D. then I assure you, anything you want is within reach. May you find the finish line for every worthy pursuit you embark on.

In health,
Michael

Interview with Edgar Schein about Organizational Culture

Dr. Edgar Schein is one of the most prominent organizational development figureheads alive. He earned his Ph.D. in social psychology from Harvard University and went on to teach at the MIT Sloan School of Management reaching Professor Emeritus distinction. Along with numerous academic publications, Dr. Schein has a long list of books that cover various organizational topics such as group process consultation, career development, and of course, organizational culture. His titles include Organizational Culture and Leadership, Helping, Career Anchors and Humble Inquiry.


1) You have stated recently that the concepts of organizational culture that are often disseminated from your original work on culture need to now be viewed differently. What is one of the biggest misconceptions — regarding the way your work is used today — that you would like to see better aligned with our current understanding of organizational culture?

From the beginning, I have argued that culture covers everything a group learns in its evolution. That includes external understanding of the environment so that you can survive and grow. Internally, that includes figuring out how to get along. I think today’s usage of the word culture is almost exclusively number two. It’s discussed in terms of workplace culture and how to get better engagement; how to get people to work in teams; how to be more service oriented. People use the word, culture, as almost exclusively geared at how to make employees happier and behave differently according to some notion of what management thinks might be better. What gets ignored is the role of culture in defining strategy, and mission, and how we’re going to get organized. All these concepts are also part of culture, and they are almost never really referred to now in most of the current, popular managerial literature.

2) Few (if any) would question the merit of your ideas around leaders needing to be more helpful and the concepts of humble inquiry. In environments that are inherently fast-paced (ex. medicine) what are a couple useful strategies to utilize these methods where time is scarce? 

One misconception is that humble inquiry is a slow, tedious and long-running process. I can see how it could easily be interpreted that way. But, my experience has been that, if a leader — whether it’s a doctor or whoever — who has time constraints, still wants to be a humble inquirer, you can do that by being more personal. So, my best example is, I’ve recently talked to several doctors and they complained bitterly about the degree to which they only have a few minutes with a patient because of all the other stuff they have to do. So, recently, whenever I’ve been with a doctor and we get into this discussion I coach them to lean over, touch the patient on the shoulder, and say in effect to this person, “As you may know, in the present system, I only have ten minutes. So, let’s make those ten minutes count.” My hunch is that, if you say something like that, it would immediately relieve some of the pressure and would enable both of them to be more open and personal — saying what’s really on their mind. So, it’s use of time, rather than the absolute amount of time that I think makes the difference. What I want to teach leaders is to see how they can very quickly personalize their relationship with their subordinate, or client. When successful, what then transpires is good, open communication rather than a formal dance of do I trust the other person, etc., etc. That may take a lot of time in some instances, but there’s nothing arbitrary that says it’s got to take at least an hour, or a day, or whatever. It’s really how you do it that matters.

3) Previewing my own research a bit, I have found during the process of my dissertation — contrary to popular advice that effective workplace wellness requires leadership actively architect “positive” company culture — successful wellness programs in small to mid-size businesses flourish when leadership is not evolved. Successful programs instead seemingly share the commonality of beginning as an internal well-being movement, spearheaded by (what is perceived as) a neutral advocate. You have discussed previously that “concepts” do not have cultures, groups do. A working theory of mine (in this context) is that well-being is better supported by an organization when employees do not feel coerced by tactics pushing them towards a preconceived definition of “wellness.” If that’s true, are there any tactics leadership can use to inspire a healthy culture other than giving this cohort autonomy?

The leader doesn’t have to participate, but they have to believe that whatever is going on at that middle level is worthy of support. So the distinction you have to make is not that leaders have to be involved, but that leaders have to be aware of what’s going on and be supportive. I can give you lots of examples of that. An interesting example (in regards to your question) would be, if you found some middle-level-generated programs that succeed where the leader is indifferent.

There are a lot of touch-feely programs out there. The leader comes in and discovers for the first time you are engaging in one of these type of programs and says, “What? You’re meeting in this group? No more of that.” There are plenty of examples where good programs are being killed that way. The problem is that middle managers and/or their staff do not explain well enough to leaders what they were actually doing. If they learn that the employees really like this stuff, they are generally not going to kill it — unless it really violates some of their own assumptions about what employees should be doing. The programs that I’ve seen killed, for example, are where employees will get into a T-group program sponsored by HR, and then an executive takes notice and sees them engaging in various kinds of emotionally charged feedback activities. The executive gets horrified, and says, “Who launched this program? I’m not going to have any more of that in my company.” That’s the kind of thing that can happen if leaders aren’t well-oriented to what the program will actually involve.

4) In your extensive look at the role culture plays within organizations, what are your thoughts on the impact culture can have on influencing and/or impacting personal well-being (outside of what we discuss above)?

My basic view is that culture covers everything that goes on in the organization unless it’s a brand-new organization and no culture is yet formed. But, assuming that the group or the company has some history, the culture will determine both what people regard to be the right way to work and how to feel about it. So, you can have a culture, which we used to have a lot of in the auto industry and so on, where what the person expects is a fair day’s work for a fair day’s pay. As long as I get my pay and I have reasonable working conditions, I don’t expect my company to make me happy. I expect my company to give me a living. And, if that’s the cultural norm, as it was in many organizations in the past, then you can’t say this is a bad culture because employees aren’t happy. It is what it is and employees have accepted it. Now, what seems to have happened is, in the last 25 years, is employees are beginning to say, “A fair day’s work for a fair day’s pay isn’t good enough for me. If I spend all this time at work, I want to feel better.” That spawned organizations like Great Place to Work. Organizations like Great Place to Work make their money because a lot of employees think this stuff makes a difference. They believe, “How I feel at work is important.” If the boss gets concerned and says, “Gee, I want to be an organization that makes my employees happy because there’s some evidence, at least in some industries, that safety and quality actually is better if employees feel healthier and happier.” There’s enough research now that bosses are beginning to believe that this is real. So, suddenly, they want to change their culture. But, if they’ve spent 25 years building a fair day’s pay for a fair day’s work kind of culture, you can’t just now say, “OK. I’m going to bring in a couple of consultants and we’ll create a healthy culture.” It doesn’t work that way because you’ve trained all your supervisors and all your managers to be impersonal, and bureaucratic, and that’s the way the place has worked forever. So, now suddenly, you discover the employees aren’t happy… so what are you doing to do? Well, you might from the very top have to start treating your own subordinates differently because your own subordinates are also part of that cultural system. So, when people say, “I now want healthy and happy employees,” they generally don’t realize that whether or not they can get there depends very much on the culture that’s already there, the culture they have built over however many generations. Therefore, they can slowly begin to evolve their culture in a new direction, but that also means changing your reward system, changing the way people are managed, changing all the fundamentals of the organization.

5) You have recently focused some of your work around humble consulting looking at intimacy as it applies to working relationships. Sheryl Sandberg has discussed that it is the fear of perceived intimacy that holds men back from creating strong professional bonds with female counterparts. Have you unearthed anything in your recent work that might mitigate this risk (other than common sense)?

When my Humble Consulting book comes out, which will be shortly, you will see that I make a big distinction between three levels of relationship. One is sort of the bureaucratic “stranger” relationship. Level two is what I’m calling a more “personal” relationship. Then, level three is what I’m calling “intimate” relationships. So, the question is, are we using intimate in the same way as Sheryl Sandberg? I’m arguing that level two relationships, which are always appropriate, is what you would call a personal relationship. I know you as a whole person… I am responding to you as a whole person. The question of what is appropriate in the workplace between men and women, I think it’s totally appropriate for both to get more personal around the tasks that they have to perform. But, that should not imply they need any more intimacy, sexual or otherwise.

The definition of intimate becomes crucial in this discussion. In U.S. culture, one might think that the word immediately implies this deeper male-female kind of stuff. And, that would certainly be a misuse of a working relationship. Therapists and lawyers aren’t supposed to be intimate with their patients and clients, but they can be very personal in how they structure the relationship so that good information and trust is built up. So, that’s the distinction, but I cannot specifically answer this question because I do not know how Sandberg has defined the word for her work.

The trick is to be aware that society’s rules always apply. What society decides as inappropriate intimacy applies across the board. You can’t say, “Well, in my company, we’re going to use different rules.” The key is for you, or me, or anybody to play by cultural rules because those rules apply to all these situations. Then, within that say, “Okay. I can’t be intimate, but as a boss I can sure have a better relationship with my subordinates by at least getting more personal.”