A few years ago, the Walt Disney Co. launched a Twitter hashtag, #CastCompliment, for the express purpose of promoting the good work their employees do. The millions of visitors to Disney parks are encouraged to tweet about their positive experiences with performers who embody the company’s movie and TV characters across the grounds.

“The employee’s supervisor retweets the compliment, along with a picture of the employee,” according to Inc.com. Bruce Jones, a senior programming director at Disney who blogged about the program, called it “an opportunity to create some magic with the positive tweets.”

That kind of recognition—praise for good work that fellow employees and even the public can see—may be a surprisingly effective way to help address a disturbing trend in business today. Though unemployment in the U.S. is at about its lowest point in 50 years, worker satisfaction remains alarmingly low. Gallup, the polling organization, "reminds us every couple of years that nearly 70% of employees are actively disengaged” at work, reported Forbes. The Conference Board, a business think tank, found that only 51% of American workers report overall satisfaction with their job, according to its recent poll.

Companies have strong business reasons for keeping employees happy, since it reduces employee turnover and boosts productivity. Many factors play into worker satisfaction, including compensation and benefits, but "the No. 1 factor in job satisfaction is not the amount of pay but whether or not the individual feels appreciated and valued for the work they do," wrote psychologists Gary Chapman and Paul White in The 5 Languages of Appreciation in the Workplace.

Recognition can be a big part of showing appreciation, according to a study in the Harvard Business Review. Among the 512 U.S. employees surveyed who said their company has strong recognition practices, 87% reported feeling “a strong relationship with their direct manager.” That number tumbles to 51% out of those workers who reported “a lack of such practices at their companies.”

“Recognition’s frequency also plays a role,” the report continued. “For those who say they receive some form of appreciation more than once a month, 82% describe a strong bond with their bosses. When that occurrence drops to less than once a month, only 63% feel those strong ties.” The study also found that public recognition in the workplace not only has “a powerful effect on those being called out, it also has a significant impact on peers who see great work being rewarded.”

If idea of public praise has proven merit, then what methods are best? The execution needs to be tailored to the organization and the worker. It can range in style from ostentatious to subtle—and even silly.

Red Velvet Events, an Austin-based company, awards a small plastic troll doll, reports Entrepreneur. During weekly staff meetings, a Red Velvet team member hands over the doll “to another employee and describes the recipient’s work efforts during the previous week. Each person who receives the doll gives it another accessory (earrings, a tattoo, a bow tie, etc.) and presents it to another team member the following week.” The “quirky tradition” reflects the company’s “fun-loving culture” and “ensures employees are consistently being recognized for their hard work by the people who see it first hand: their team.”

The team at Nooklyn, a Brooklyn-based real-estate firm focusing on apartment rentals, collectively participates in employee recognition on its digital platform. Because all the company's stakeholders are plugged in to the platform—the agents, the accountants, the legal team—they all can see how a potential closing is progressing.

Harley Courts, Nooklyn’s cofounder and CEO, says the company has incentivized teamwork by increasing commissions for members of a group who collaborate in getting a deal done. Those efforts can be seen by all. (Courts, a lifelong skateboarder, says he wanted to generate the sense of community typically found in that world, in contrast to the often individualistic nature of the real-estate trade.) When a closing is on the books at Nooklyn, it sparks a gif- and emoji-fueled celebration on the company’s Slack feed, with employees customizing the artwork to reflect certain details of the deal, including its players.

“Everyone cheers everyone on,” Courts says of the time when a closing at Nooklyn is finalized. “Everyone is psyched. … It’s so embedded in our culture that when you join, you’re like, ‘Wow, I really just went to Mars; this completely is not normal,’ especially people who come from the real-estate industry.”

Yet in giving shout-outs, managers need to be sensitive to the personalities of the recipients. Management consultant Ted Boyce says worker recognition in general is a good way for executives to get engagement out of its team members, but not everyone welcomes it. “There are some people who just don’t like that kind of attention, so something that is intended as a positive becomes a negative,” Boyce says. “They get a little embarrassed.”

At the same time, he cautions against a phenomenon he calls the “Awards-Show Syndrome,” where “those that feel that they are worthy of recognition feel left out,” he said. “So you may be recognizing one person at the expense of others who are feeling … undervalued,” Boyce observes. It takes a certain level of knowhow to carry out employee recognition successfully, he added. “What I worry about is you’ve got folks who may not have expertise in human behavior that may be going about it the wrong way.”

The right way to do it, said Joe Robinson, a noted work-life balance trainer and speaker, is to personalize the praise, offering "not just off-the-shelf ‘Way to go!’ Or ‘Great job!,’” he wrote in an email. “The key is recognition that goes to the competence, a core psychological need, of the employee.” A better way is something along the lines of “I like the way you did that job.” Such a framing “speaks to the talent and effectiveness of an employee,” Robinson said, “and that lasts, unlike the generic ‘nice work’ kind of recognition.”

The leaders at Geocaching HQ, a Seattle-based company that produces a GPS-powered, outdoor treasure-hunting game, are certainly mindful about how they recognize employees. Their managers are encouraged to ask employees how they would most like to be recognized as part of a questionnaire called a “fire starter.”

The fire starter is filled out during periodic reviews to generate expectations and “set the manager and employee up for direct success,” according to Eileen Kim, a human-resources manager at Geocaching. Other fire starter questions, according to Kim, include “What do you feel passionate about developing this year?” and “What do we need to ramp up in your role?”

The collected data about how their workers might want to be recognized has led to what Kim describes as “a public kudos system” where employees can write “Beyond the Everyday” nomination notecards for peers of their choice. “These notes are posted publicly throughout the month in our community kitchen,” Kim says, “and during our monthly company meetings, three cards are randomly selected. They are each read aloud, and the nominee and nominator get a coffee gift card to spend together.”

The methods of employee recognition at Geocaching HQ don’t stop there, and aren’t limited to direct responses to a job well done either.

When Kim recently lost her dog, the company’s pet-bereavement policy allowed her to take a week off from work. When she returned to the office, she says, her desk was covered with cards, flowers and cakes.

“My CEO actually planted a tree in my dog’s honor,” Kim says, and recounts that another employee started a GoFundMe campaign in Kim’s dog’s name to raise funds for a senior-dog rescue house. The coworker raised more than $400.

“How do you encapsulate that feeling?” Kim says, her emotions palpable in her voice. “The whole team just rallied and swarmed [around me] to make me feel supported.” Kim says that experience contributed to her feeling more like she was part of a family, as opposed to any old corporation.

Employee experiences like Kim’s may be one of the reasons Geocaching HQ has been recognized each of the last eight years by Outside magazine as one of the best places to work in the U.S.

They seem to be doing something right.

Michael Stahl is a freelance writer and editor. A former high school English teacher, he has written for Rolling Stone, Vice, The Village Voice, Narratively, Splitsider, Outside and other publications.

ADHD in the Workplace: What You Should Know–and What Can Help

Pete came to our weekly psychotherapy session frustrated with work. He had just returned to his office, post pandemic, and found the new, open plan noisy and overwhelming. Pete, which is not his real name, has attention-deficit/hyperactivity disorder (ADHD) and is easily distractible and sensitive to noise. He had trouble concentrating, was irritated by the constant chatter of colleagues, and, as a result, was feeling less productive.“Could you talk to your manager about getting some accommodations?” I asked.“No way!” he said. “That would be a career killer.”Pete’s wariness is not uncommon. A few of my psychotherapy patients with ADHD have confided in their managers, but most feel it’s unwise to do so. They fear they will be stigmatized and sidelined.Edward Hallowell, M.D., agrees with their concern. The founder of the Hallowell ADHD Centers and one of the leading authorities on the disorder, explained to From Day One: “We’re not there yet. Most corporate professionals think of ADHD as some kind of mental illness.”Given that ADHD is not well-understood in the workplace, how can employees speak up about their needs in a way that feels safe? And how can managers and HR leaders better understand how to respond to those needs–whether employees want to name their ADHD, or not? A well-accommodated employee is, after all, a happier and more productive one. “It’s in everyone’s best interest to remove obstacles to someone’s performance,” said Hallowell. Here’s what experts recommend:Know What It IsADHD is a neuro-developmental disorder characterized by symptoms of restlessness, impulsivity and difficulty sustaining attention to boring tasks. It tends to run in families and is often inherited from a parent. There are three types: inattentive (dreamy and distractible), hyperactive-impulsive (restless and talkative), and a combination of the two. Most adults with ADHD have the inattentive type. Though it was long considered to be a childhood disorder affecting mostly boys, research has shown that it persists into adulthood—about 30% to 70% of children with ADHD continue to have symptoms later in life.Ned Hallowell, M.D., a pre-eminent expert on ADHD (Photo courtesy of the Hallowell ADHD Centers)An undiagnosed adult may think of themselves as spacey, messy, or undisciplined—and they often suffer from low self-esteem. A recent study found that only 10% to 25% of adults with ADHD receive an accurate diagnosis and adequate treatment. “They are often inaccurately diagnosed with anxiety or depression, which are really just the fallout of untreated ADHD,” said Ari Tuckman, a psychologist in West Chester, Penn., who specializes in the treatment of ADHD. As Hallowell puts it: “It’s like driving on square wheels.” In dealing with tasks, you will make progress, but it may take longer.And That the Diagnosis Is On the RiseWhile children are still the most likely group to be identified with the disorder, the number of adult diagnoses has been rising for decades. The pandemic accelerated the trend: the overall incidence in adults (30 to 49 years old) nearly doubled from 2020 to 2022, fueled mainly by an increase in diagnoses among women, according to Epic Research, a medical-record software company. While it’s not clear exactly why women are being diagnosed more often, experts theorize that it may be due to increasing smartphone and technology use, which can amplify distractibility and stress, as well as a greater awareness that ADHD can be also be a women’s issue. As more adults are diagnosed, they—like Pete—often face workplaces that are not ADHD-literate.How It Affects Work Performance–But Not Always in a Bad WayPeople with the disorder may have difficulty with organization, time management and procrastination—all of which can make it hard to meet deadlines and work within teams. They find tedious tasks, such as scheduling and filling out expense reports, unusually challenging and have a different sense of time than others. “People with ADHD have more difficulty seeing time and feeling the future,” notes Tuckman,More than half (56%) of adults with ADHD said they believe the disorder “strongly impacts their ability to succeed at work,” according to a 2008 survey by McNeil Pediatrics. A more recent survey by Akili, a therapeutic-technology company, interviewed 500 adults with ADHD and found that employees with ADHD felt the disorder had a negative impact on their career. And yet, people with ADHD often display qualities that work in their favor, notes Hallowell, who himself has ADHD. He sees the condition as a trait, not a disorder, that has positive benefits like creativity, humor, and spontaneity. “There’s more to it than most people realize,” he said. “ADHD is terrible term. We have an abundance of attention. Our challenge is where to put our focus.” People with ADHD can spend hours on topics that interest them and see details that others might miss, a trait sometimes called hyperfocus. Many successful people have talked openly about their ADHD, including Michael Phelps, Simone Biles, James Carville, astronaut Scott Kelly and JetBlue founder David Neeleman.How to Get DiagnosedIf you persistently miss deadlines, are chronically late, and feel like staying organized is a big effort, first ask a trusted friend or colleague if they find you more scattered than others. Then, make an appointment to see a psychologist or psychiatrist who specializes in treating the condition. There is no one standardized test—instead a professional will take a thorough history and may ask family members and friends to complete questionnaires about your behavior. You may be asked questions like, How often do you misplace items, feel bored and restless, or lose track of what needs to be done? If you meet the criteria, your doctor may talk to you about medication, therapy or coaching and, if needed, provide a diagnosis so you can receive accommodations at school or at work.Understand What HelpsMost people diagnosed with ADHD rely on medication to control their symptoms. Typical medications include stimulants such as Ritalin and Adderall, which increase the levels of the neurotransmitters dopamine and norepinephrine in the brain. There are also non-stimulant drugs such as Strattera. Stimulant medications that treat ADHD are the “most effective of medications in psychiatry,” said Tuckman, and help tame distractibility and impulsivity. About two thirds of people with ADHD diagnoses are prescribed stimulant medications, and that percentage has remained fairly consistent since 2013, according to Epic Research. Some people can help manage their symptoms by exercising regularly, getting proper sleep, and implementing strict organization and reminder systems. Or they hire very competent assistants.Once you are diagnosed and have figured out the best treatment, it’s like “getting fitted for the right eyeglasses,” said Dr. Hallowell. “Things come into sharper focus.”How to Make the Workplace More ADHD-FriendlySmall modifications can go a long way to helping people with ADHD perform better on the job. Tuckman suggests considering adjustments in the three domains described below. As an employee, you can make tweaks on your own or ask your manager for help. As for managers, if you have a worker who is struggling with organization and meeting deadlines, you could take the lead at putting these practices into place.Make distractions softer. Quiet spaces, headphones, and working on off-hours (say, early or late), can help mitigate the clatter of a bustling office. Often working from home is a good solution.Make important information stand out from the chatter. Putting assignments in writing, recording meetings, and highlighting deadlines can help workers whose focus is not great to stay on task.Bring the future closer to the present. Those who struggle with adhering to deadlines will benefit when big projects are broken into smaller chunks, and check-ins are on the calendar with frequent reminders of when tasks are due.So, Should You Tell Your Boss?If you have ADHD, you may be covered under the Americans with Disability Act (ADA). However, you might not want to play that card unless you absolutely must, says Belynda Gauthier, a retired HR director and past president of Children and Adults with ADHD (CHADD). “The first time I did a presentation on ADHD in the workplace, I launched into detail about how the employee should approach his supervisor or manager and suggested that he might want to go directly to HR first. An audience participant interrupted to tell me that her HR office actually is the problem for her. Oops! I took this to heart, did some serious thinking, and revamped my presentation. I no longer recommend revealing one’s diagnosis until and unless it’s necessary.” Indeed, 92% of surveyed adults with ADHD believe that their colleagues hold misconceptions, the most common of which is “people with ADHD just need to try harder.” A better strategy might be to simply approach your manager with a positive attitude and a few solutions. “Be sure to tell them what you are good at,” advised Hallowell.Gauthier suggests something like: “I am really enjoying processing these widgets, and I think I’m doing a good job. I believe I could do an even better job if I could move to that cubicle that’s farther from the copy machine. So many co-workers use it all day and everyone stops to say hello.” Avoid the use of the word “but” to qualify your suggestions and don’t be whiney, she says. Accommodations can help, but sometimes the best solution is finding the right job in the right environment with the right supports. “When I finally figured out I had it, it was a relief,” David Neeleman said in a recent interview with Forbes. “I was just really careful to surround myself with people that could complement my ADHD. I have people around me that help implement a lot of the ideas I have.” When you can turn your intense focus on something that truly fascinates you, ADHD can be a bonus rather a deficit.Lesley Alderman, LCSW, is a psychotherapist and journalist based in Brooklyn, NY. In her therapy practice, she works with individuals and couples. She writes about mental health topics for the Washington Post and has been an editor at Money and Real Simple magazines and a health columnist for the New York Times.(Featured photo by Valentin Russanov/iStock by Getty Images)

Workers Want Weight-Loss Drugs, But How Can Employers Pay the Bills?

When consumers see splashy TV commercials for weight-loss drugs, they often find the the pitch irresistible. But for HR and benefits executives, they may trigger an uneasy feeling. That's because the revolutionary weight-loss drugs like Wegovy bring with them both magic and mystery–the magic is how well they can work; the mystery is how to pay for them.GLP-1, or glucagon-like peptide-1, drugs have historically been used to treat diabetes. But the development of stronger drugs like Novo Nordisk’s Ozempic in recent years, and now the approval of Wegovy and Eli Lilly’s Zepbound specifically for weight management, has led to a sharp increase in demand. That’s particularly true as more research emerges showing the drugs may also reduce the risk of cardiovascular disease, stroke, and potentially bring other long-term health benefits. Yet the medications can cost as much as $1,000 to $1,500 per month–a price that few Americans can afford unless they have generous health-insurance coverage.And unlike expensive drugs for rare conditions, the potential number of patients for GLP-1s is vast. More than 40% of Americans have obesity, according to the Centers for Disease Control and Prevention, and that is expected to reach 50% by 2030.Many doctors are thrilled about the potential for GLP-1s to change how obesity is treated, but that puts employers–where nearly half of Americans get their health insurance–in a tricky position. Here’s what employers need to know as they consider coverage for these drugs in the quickly changing landscape:High Costs, Low CoverageWhile employer health plans widely cover GLP-1s for the purpose of treating diabetes, coverage for weight-loss purposes is much more spotty right now. A survey last fall by the International Foundation of Employee Benefit Plans found that 27% of 205 employers covered GLP-1s for weight loss and another 13% did not yet cover them but were considering adding coverage. Meanwhile, Willis Towers Watson (WTW), a global insurance benefits-consulting company that serves many large employers, found about 38% of employers it surveyed cover the weight-loss drugs. Those that do cover them are seeing significant cost increases. The retail price for Wegovy comes out to $15,000 to $16,000 per year, and after rebates and discounts from manufacturers, health plans still pay about $9,000 per year, says Cody Midlam, a director at WTW’s pharmacy practice. The cost per member per month for GLP-1s has doubled each of the last three years, according to WTW’s analysis, amounting to an extra $11 per member per month last year, or about 9% of all pharmacy costs.Companies are aware of the research showing the drugs’ effectiveness at tackling obesity. Yet while doctors say that helping people lose weight could lead to less cardiovascular disease, fewer mental health issues, and savings from avoiding knee replacements or other surgeries related to obesity, long-term data on clinical outcomes remains limited. With high employee turnover in many industries, it’s tough for these employers to factor in potential future savings in healthcare costs over the life of the employee.“Those outcomes take a very long time to manifest,” says Midlam. “It’s not something that’s easily measurable on a short timescale when plan decisions are being made.” Andrew Witty, CEO of UnitedHealth Group, the largest U.S. insurer, said his corporate clients see the benefits, but first have to deal with the short-term costs. “We’re very positive about the potential for another tool in the toolbox to help folks manage their weight. We recognize that has potential benefits,” Witty said in the third-quarter earnings call last year. “But we’re struggling.”Employers Meet the DemandDespite the high costs and headlines about some insurance plans scrapping GLP-1 coverage, plenty of employers see the upside to covering the new obesity medications. Ninety-nine percent of companies already covering GLP-1s said they planned to continue doing so next year, according to a fall survey from Accolade, a healthcare navigation and advocacy company. Employers reported that after they added GLP-1 coverage, they saw higher employee satisfaction, increased engagement in other well-being programs, and improvements in other or comorbid health conditions. Midlam of WTW says his firm’s corporate clients want to “avoid member disruption” wherever possible.Doctors agree that should be a priority. Dan Azagury, M.D., medical director for the Stanford Lifestyle and Weight Management Center, says GLP-1s have been a “game changer” for many of his patients. “If you stop it overnight, whether it’s insurance, or financial, or shortages, the rebound is ferocious,” he said. “So it’s really very frustrating that they encounter that situation.” Some companies have expressed concerns about the idea of paying for a drug that employees essentially have to take forever to maintain its benefits. But while side effects, including vomiting and gastrointestinal issues, can be unpleasant for some people, doctors like Azagury say they know how to help patients manage them, and that they are seeing more patients have a positive response to GLP-1s than to previous generations of weight loss medications. Holistic Care, Not Just PrescriptionsEven when employers decide they want to help their employees lose weight, there are still lots of details to consider. As companies approach designing their insurance plans for 2025 and beyond, they are trying to figure out how many employees are likely to use GLP-1 drugs if coverage is offered, whether there should be limits on who can get the drugs, and what kind of requirements they should use to prove the drugs are medically necessary. Most companies that cover GLP-1s use some cost-control strategies, according to the International Foundation of Employee Benefit Plans survey. Many use prior authorization, step therapy during which patients must try lower-cost drugs first, or specific eligibility requirements.Typically, eligibility requirements have been tied to the standards on the FDA labels for these medications. But some employers are considering restrictions such as only covering the drugs for people with obesity but not those who are overweight, says Tracy Spencer, a pharmacy practice leader for benefits consultant Aon. If they add those limits, she warns that employers should be aware that could change or jeopardize the rebates they get from the drug manufacturers, so they need to predict whether the savings they get from limiting the drugs’ use will offset the loss of the rebates.Benefits consultants like Aon and WTW are also seeing employers shift the way they look at GLP-1 drugs to view them as one piece in a broader strategy to address cardio-metabolic issues.That might mean employers choose to cover the drugs for targeted indications, such as covering Wegovy not for weight loss on its own, but for people with increased risk of cardiovascular disease, which Medicare recently announced it would do. It can also mean pairing GLP-1 coverage with required lifestyle modifications or participation in a virtual weight-loss or coaching program. Employers often have access to virtual health programs through their pharmacy benefit managers, and many have tried these to target diabetes in recent years. The biopharmaceutical company Moderna, which offers coverage of GLP-1s for diabetes and weight management, is one company that has tried this strategy. “In 2023 we saw a spike related to weight-loss management: We looked at claims data, and after mental health, obesity and weight management were the second drivers,” Jeffrey Stohlberg, Moderna’s director of corporate benefits, said at a From Day One conference earlier this year. So the company started using the virtual weight-loss management program Wondr Health, where an employee can work with a physician specializing in weight loss. “It’s not a path to GLP-1s, but [the physicians] can provide medication for that person,” Stohlberg said. Labcorp also announced in February that it would provide U.S. employees on GLP-1s with virtual care and medication management through WeightWatchers for Business. Other companies such as Omada Health and telehealth providers like Teladoc and Ro have launched similar offerings over the last year. Medical providers agree that a holistic approach is needed, but Angela Fitch, M.D., president of the Obesity Medicine Association and co-founder and chief medical officer of the obesity-focused primary care startup knownwell, worries that requiring a standard weight-management program for every person is another barrier and potentially a waste of money if the program doesn’t have solid evidence behind it.“You can offer lifestyle [strategies] in addition to medication,” she said, “but it should be driven by that shared decision making discussion with the clinician.” If insurers want to make sure patients are getting holistic care, she would rather have them require patients to get their prescriptions from a qualified physician who does a true evaluation so that solutions can be personalized. In her role with the Obesity Medicine Association, Fitch often advises employers on their health plan designs, so she understands that costs are a major concern for companies. But in her primary-care practice and others like it, she says her staff are “burning out” as they spend hours each day trying to navigate all the new and often strict and confusing insurance requirements for these medications. “We have got to deal with costs,” Fitch said. “But it should be transparent and flexible.” She worries that overly rigid restrictions are “adding to the bias and stigma of obesity” by signaling to patients that their weight is their responsibility to treat on their own. Her major advice is to view obesity with the nuance that people view other chronic conditions. “You do not need a GLP-1 management solution. You need a comprehensive obesity-care solution.”Abigail Abrams is a health writer and editor. Currently she is the senior manager of content operations for Atria. Previously, she was a staff writer on health and politics for TIME magazine. Her freelance work has appeared in the Washington Post, the Guardian, and other publications.

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