Every employer will agree that healthy and happy workers are more productive and efficient. What might not be as universal is how to execute on creating and maintaining a culture of health.

“Healthy employees are happier and more engaged,” claims Susan Morgan Bailey, manager of wellness and health promotion at DTE Energy. “And the organization also becomes more successful.”

The wrinkle is how to execute: Living a healthy and active lifestyle is about making personal choices—but how much influence should an employer have over workers’ behavior and choices? Holding workers accountable is another problem.

Moving employees across the behavior-change spectrum from awareness, to action, to well-established healthy habits is critical and challenging for employers, says Eric Zimmerman, Chief Marketing Officer at RedBrick Health.

The excuses for delaying quitting smoking, skipping exercise and not changing lifestyle habits are endless, and Kim Berdinsky, senior benefits manager at Alliance Data, can attest to the challenge of holding employees accountable: In 2003, a corporate claims analysis showed that 60% of Alliance workers suffered with preventable health conditions, meaning they could have been prevented through lifestyle behavior changes. Weight levels topped risk factors for employee health year-over-year, yet in health assessments in the company’s traditional wellness plan, associates said despite their willingness to lose weight, they weren’t seeing results.

But today, employers like DTE and Alliance are making employees more accountable and responsible for health/ lifestyle choices notching up their wellness strategy. The companies are taking a small-steps approach that they say is reaping big results.

“Micro changes reshape daily patterns with social support and all kinds of reinforcements,” says Zimmerman. 

“Behavior change occurs when employer programs help people have a sequence of small successes is what it boils down to,” claims Dr. BJ Fogg, director of the Behavior Design Lab at Stanford University. “Taking baby steps helps build confidence and moves people forward to take on bigger things.”

Baby steps

Big lifestyle changes don’t happen overnight and people will also not change if they are given unrealistic goals. “It’s a systemic mistake to create programs designed to change every aspect of life,” claims Fogg who advises corporate wellness executives, health consultancies and health plans.

Weight loss has long been a corporate value at Alliance, but the company shifted the mindset of “eat healthy to lose weight” to “try a new vegetable today.”

Every time people fail to change behavior they become less capable of future change, claims Fogg.

But breaking things down makes a behavior change sustainable. Baby steps result in people doing more small things naturally so that eventually they change their understanding of the world and essentially their environment.

For example, a health behavior correction for an employee who is not exercising might involve a recommendation that the person exercise five minutes daily. “Little by little, the person changes her environment to make walking easier,” says Fogg.

Little changes are easily incorporated into life. “Every day when heading off to work, you grab your briefcase, and then add a step like grabbing a bag of carrots from the fridge,” says Berdinsky. “One day it turns into a habit.”

Bailey says in 2010, DTE dovetailed the company’s functional purpose with personal energy management. The new program resonated with employee lives, focusing simply and incrementally on eating, sleeping and stress management, the underpinnings of good health and workplace and life performance and satisfaction.

“It’s a rare day when I don’t walk around and hear people talking about blood pressure,” says Bailey. One employee even ‘complained’ she couldn’t get through the hall during break because the hallways were so clogged with walkers.”

Hard numbers back the anecdotes, says Bailey. In three years, employee preventive care adherence increased to 67.6% from a baseline 51.5%. This represents an increase of 16.1 percentage points or a relative increase of 31.2%.

Tailored communications influence successful outcomes. Berdinsky says 80% of employees, on average, participate in the Alliance wellness effort, and health costs are approximately 20% less than at other comparable companies.

Communicating and measuring change

Keeping employees on track is all about communication.

 DTE developed an Internet-based website to share positive employee stories in outreach to a geographically dispersed workforce.

 In addition, Evive Health, a third-party vendor mines DTE’s health data and sends a tailored communication to remind employees it’s time for a physical and includes the employee’s physician phone number as an actionable trigger.

Berdinsky claims partnering with third-party vendors helps retain privacy and builds employee trust. Trust helps circumvent rankled employees and their developing a “who are- you-to-tell-me-to- follow-this-dynamic attitude,” says Fogg.

Despite the anonymity, personalization is important. With every step, employees choose their focus and preferred communications medium, says Kyle Rolfing , RedBrick’s founder and president. Using social media, for example, an already active employee might choose a smart phone to connect to Fitbit or Runkeeper; someone who’s a borderline diabetic might want to zero in on nutrition.

Rolfing says employees can log in anything from how many miles they’re running to photos of the healthy foods they’re eating accompanied by a table of caloric intake—all as they begin to value the health ROI gained from their own hard work.