As we endure another month of the Great Resignation, Great Reshuffle, or Great [Insert Word Here], creating and maintaining methods to retain employees gains importance. While pay and leave issues are always vital to employee retention, there is an increasing emphasis on maintaining and improving the health and well-being of employees as a method of attracting and keeping talent.

At a recent webinar on “Making Health Care More Inclusive for All Your Employees,” From Day One brought four corporate experts together to talk with Fast Company staff editor Lydia Dishman about how to make progress at a time when it’s especially needed. Their advice:

Measure More Than Money 

“There has been a shift lately to more people-focused metrics, as opposed to financial metrics,” said Jeris Stueland, an expert associate partner for the consulting firm McKinsey & Company. Working out of the Minnesota office, she is responsible for all work related to employer-sponsored health care, with an emphasis on mental health and health equity. “Historically, a lot of organizations I worked with had focused on how are they managing the funds and getting the best outcomes for each dollar.”

While that ROI still matters, these organizations are thinking differently, asking questions such as how to keep people healthy, keep them feeling healthy, ensure they don’t come to work when they are sick, and support their mental health? Money isn’t the metric when they think about mental health and well-being. “In a recent survey we did, 20% of the employers who responded said they don’t expect any return on investment for wellness and mental-health programs. They are doing it to support their employees, and not trying to measure financial ROI.”

“Metrics are critically important, and I won’t dismiss them,” said Timothy Leier, director of HR international benefits at Ecolab, the water-treatment tech company. “But too often if we wait for the metric, we miss the opportunity. We know that wellness is a hot topic right now. Instead of waiting for the metrics to show it three, six, nine months down the road, we are making sure we have more resources for associates as they face this transition that we’re going to be coming into,” as workers return to the office. “The anecdote is hard to measure, but it is also a critical component for telling us how to change our behavior.”

Georgia-based Piedmont Healthcare has a Comprehensive Employee Wellness Program. Jo Anne Hill, the executive director of diversity and inclusion, said that was a first in her career.  “Here, there was already a focus on understanding how our employees are doing and what they need.” However, the pandemic made Hill understand just how critical it was to have clarity on it. Piedmont created a portal where employees could note how they were feeling. Other surveys included questions about how they were and what they need. “You move what you measure,” she said.

Prevention Matters

Mike Sokol, MD, is SVP for clinical strategy at Quantum Health, a company that helps employees navigate their health-care choices. Over the course of the pandemic, he has seen a huge demand for mental-health-related issues and a related spike in telemedicine. “We spent a lot of time helping our members navigate their EAPs and find the right provider.”

He also noted a big drop in people having preventive screenings. “That is concerning, particularly when you have people with chronic conditions like asthma or heart disease not getting the care they need. Diabetics weren’t getting their A1C checked, people weren’t having routine visits. So now we are re-engaging with members to make sure they understand the importance of managing their chronic condition and doing the preventive screenings.”

Those items are measured, said Sokol, as are clinical outcomes. “We need to know if we are helping to close gaps in care. Are we improving quality of life? Are we seeing more satisfaction and engagement with people in taking care of themselves?”

Think About Non-clinical Determinants of Health 

Leier said if there is one opportunity that has come out of the pandemic, it’s tapping into the new practices that were adopted at large scale out of necessity. Telehealth is one. “As an asthmatic, I wanted to visit my doctor. The best way to do it is for me to grab my peak flow meter at home, get on the phone with him, and have him watch me to check that out.” Associates have also told Leier that telemedicine was an easier way to access mental health. “Some of the stigma of pulling your car up to that clinic is gone. Maybe we can hold on to that.”

Telehealth is something Stueland has heard clients talk a lot about, particularly as it relates to equity and inclusion issues. “There may be employees that don’t have a quiet place at home, or the time at home. So some employers are building quiet, private spaces in the office that can act as a virtual clinic, or even just a room with a computer the employees can use for telehealth appointments when they are at work. I think it reduces the stigma of employees leaving work for a healthcare appointment and fitting them into their day.”

The Importance of Preventive Care

Hill said she noted a need for more education about preventive care and why it’s important, particularly in the historically disadvantaged populations. “For many years, there was a myth going through brown and Black communities that for prostate issues, there was a physical exam of the prostate, and they were afraid to go. Not knowing that there is a blood test impacted preventive health. So we are looking at how to get information to people so that when they come into our health care systems, they’re not at stage four with prostate cancer, or they don’t need to have a major heart surgery.”

There was also an understandable reluctance among ethnically diverse people to get the Covid vaccine, said Hill. “I live in Columbus, Ga., right next to Tuskegee University. What happened with the Tuskegee experiment lingers. We have to be courageous and say that there were things that happened in history that still stick in the minds of communities.” Piedmont has partnered with elected officials, churches and other organizations to improve education, “so that when people come to us, they’ll be comfortable and more willing to get that preventative care.”

Reluctance to seek care isn’t just an issue for different ethnicities, but also different age groups. Dishman noted that for older people, preventive mental health care didn’t just have stigma, it was not even considered.

Stueland said she would add to that list a lack of familiarity with employer-sponsored health care. “Whether it’s because they are immigrants or their parents didn’t have it, they don’t have that education about health care in general.” Education about what is offered, why it is important, and how to access it is important for everyone, but for those who are in protected classes or who have been historically marginalized, that need is amplified. “For a significantly higher number of employees of color, as well as LGBTQ+ employees, the tools and the resources employers provided to help employees navigate the health care system are not as helpful.”

Health-literacy issues are another non-clinical determinant of health and well-being, said Sokol, as is appropriate care for special populations. He mentioned transgender people who may find it difficult to locate providers who are supportive, open, and have experience with their community and its particular health needs. Quantum has partnered with the World Professional Association for Transgender Health to make sure that they have a list of such providers available.

Use a Variety of Connections

There are different methods available to educate and engage people, said Sokol. Some prefer apps, some prefer telephones. Some others may still prefer paper. “We make sure when we have conversations with members we ask the questions about what kind of messaging they like, what are the social determinants to health that impact them. Do they have enough healthy food? Is their home environment safe? Do they have access to transportation? If we identify barriers, we can support them.”

Leier joked that he is sometimes called a Luddite. “Even though I spend most of my days on a computer, I don’t necessarily go to my cell phone as my first mode to get answers. For some of our plants in warehouses, getting something out on paper can be even more critical than making sure we’ve got an app for our field sales and service workers.”

How to provide information and what information to provide also depends on the geographic location, he added. “The way I handle LBGTQ issues in Saudi Arabia and Russia is tremendously different than the way that I handle them here. There’s also the subtleties that don't at first come to mind. If I’m dealing with our facilities in Roscoe, Ill., and Beloit, Wis., they have a very different set of circumstances than New York City. I make sure we’re listening to the associates, and their managers, and talking to folks in those local communities. It helps us do a better job of communicating and merchandising the offerings that we’ve got available so that we make sure people can access them appropriately.”

Build Relationships, Gain Insight

Sokol said if you aren’t regularly reaching out to ask questions about access and other non-clinical information, situations can become expensive–emotionally, physically, and financially. He mentioned a member who was racking up large bills to the employer for an ambulance transportation service. It turned out he didn’t have the means to repair a wheelchair ramp, so he couldn’t get out of his home to get in a car or cab for appointments. He was embarrassed, and it took several conversations to coax the information from him. When they found out, Sokol said they located a Boy Scout troop looking for a community project. The scouts repaired the ramp. The member was happy, the employer saved thousands per month, and the troop was able to connect with someone in need in their community.

Another example involved a member whose husband had died of cancer. The nurse who worked with her–Quantum calls them Personal Care Guides—was concerned about her. She found out the woman couldn’t afford her husband’s burial, which was impacting her health. “Because they had this relationship, the woman admitted to the nurse that she didn’t have the money and wasn’t taking her blood-pressure medication.” The nurse was able to muster resources that took that worry off the patient’s mind and allowed her to focus on her health.

Hill said it’s important to go to the source for information. “If you want to know what Jo Anne wants, ask Jo Anne. My husband or son or sister won’t get to what I want. Jo Anne doesn’t need child care, but something else. So we engage more with surveys and directly asking people. But we also have to deliver, or at least acknowledge you heard them.”

“I worked with an employer in rural Wisconsin,” recalled Stueland. “Their benefits team had long assumed they needed to have a very broad network, because otherwise employees would have to drive so far to get to a health-care provider. When we actually did focus groups with the employees, one employee said, ‘Look, I live in rural Wisconsin. I have to drive an hour to get anywhere.’ What they told us really matters was better mental health benefits. That was a real pain point the employer hadn’t recognized. Once we heard it, the employer was able to put in a new EAP solution.”

Sharing experiences is a great way to reduce stigma and gain insight into needs. Leier talked openly about being diagnosed with an autoimmune disease, and the year-long medical journey it took to get to a diagnosis. Steuland said her company uses Employee Resource Groups, asking the leaders of those groups to share the benefits they’ve used and the experiences they’ve had.

Some people will be worried about their privacy if they share information. Dishman wondered how companies can ensure that people are comfortable enough to answer. “Is it a matter of anonymous surveys? Maybe that isn’t best practice.”

Stueland mentioned that a lot of transgender people may not be out at work, so they won’t want to go to an HR professional about benefits related to trans care. “We saw with [Sokol’s] example that it doesn’t work to ask someone if their ramp is broken. You have to build that relationship.” Part of that is helping with the daily administrative snafus that arise–helping someone with the bill, getting something routed to the right address. “That can build trust and unlock the stronger relationships so you can have a conversation about some of these more personal health matters.”

For Hill, finding the particular path to a person’s comfort zone requires that there are a variety of options. “Sometimes people are afraid to go to HR. But we have chaplains, we have an anonymous emergency relief fund that they can access. It’s not necessarily the leader who is the most effective person. We have to let people know that we see them, we hear them, and while I may not be the person, there is someone that can get them the help that they need.”

Check in With Your Workers–Often

The pandemic and the Zoom era has made opening yourself up to employees about your situation–and seeing theirs–a little easier. When there are pets and children in the background, the walls that we used to keep around our non-work life are suddenly see-through, said Stueland. “Employers are increasingly recognizing that work, the nature of work, the way we work, our operating model, is part of what is driving mental health struggles for some employees. The feeling of needing to be always on, of having to bounce back and forth between work and home responsibilities. It’s not just that employers can offer support through that. They need to dive in and ask how to change the operating model and alleviate some of the stressors that are causing mental health challenges.”

“I think that nudges have been really effective to get information out,” said Leier. “They are a general reminder to everybody to think about something, if it applies to them. We are making it available to you.”

For instance, a holiday-related nudge might be a reminder that 30% of people in America experience some level of depression during that time. That would be the time to call your EAP or check in with your circle of family, friends, and colleagues.

Hill said it is also the job of the employer to be aware of significant changes in their direct reports and the circle around them. “When I see an actor committed suicide, people always say they had no idea they were struggling that badly. We have to open our eyes to the people around us. If we have employees and see that someone who is normally really high energy isn’t, someone needs to see that there is something different going on.”

She said she likes to hold casual in-person or virtual coffee sessions with employees, where they don’t talk about work. When they have meetings, the first part is always a check in with how everyone is doing “before we talk about what is on fire.” Know the names of your employee’s immediate family. Follow up on things that don’t look or sound right. It can make a huge difference.

At Ecolab, Leier said they have a “moment of inclusion” before every meeting, to highlight something people can be better at–diversity, inclusivity. He said he uses nudges in that way, as well, to highlight topics that are of import to employees. “It feels like a great way to pause for a second before we get into the transaction of work.”

DEI nudges come every week at McKinsey. “One of the ones we got recently was to check in with people–even in a Zoom environment,” she said. “When we go through partner elections, congratulate those who made it, but also those who didn’t get promoted. That’s another way to build human connection.”

Lisa Jaffe is a freelance writer who lives in Seattle with her son and a very needy rescue dog named Ellie Bee. She enjoys reading, long walks on the beach, and trying to get better at ceramics.