Workplace Wellness Isn't Just for Big Corporations. Here's How Small Businesses Can Build a Culture of Health. Naps, salads, open dialogue and leading by example are great places to start, says a leading workplace wellness researcher

Over the past decade, wellness has ballooned into a $4.2 trillion business. In the crowded marketplace of self-improvement, hardcore health innovations jostle with softcore supplements in the jade egg domain. Meanwhile, "hustle" culture has spawned a kind of work worship that has many people burning out and questioning how much they should really expect to get from (or give to) their jobs. In the midst of all this, workplace wellness is on the rise; more than 80 percent of large companies and 50 percent of small companies have implemented such programs. Despite their pervasiveness, big questions linger over what, exactly, works.

That's something that Dr. Ron Goetzel has devoted his career to studying. Goetzel is a senior scientist and director of the Institute for Health and Productivity Studies at Johns Hopkins, as well as VP of applied research for IBM Watson Health. He says the first idea worth considering is how we think about what "works." Traditionally, the measurement for success has been return on investment (ROI), or what a company saves on lowered healthcare costs and reduced absenteeism given how much they've invested in wellness initiatives. Goetzel does plenty of these analyses. Since 1994, he's run The Health Project, which gives a yearly award to companies with demonstrably effective wellness initiatives. He led a recent study showing that over a 14-year period, a portfolio of 26 of these companies significantly outperformed the S&P 500. The 26 companies that truly invested in wellness delivered a stock return of 325 percent, versus the S&P 500's 105 percent. Data suggests that wellness programs done right do, in fact, pay dividends.

Even so, Goetzel says that more and more researchers in his line of work are considering something called value on investment (VOI) over ROI. "It's hard to put a dollar value on happiness and motivation, on attraction and retention of talent," he says. "So a lot of companies are now thinking about value on investment. If they're spending money, and keeping people healthy — not just physically but mentally, socially, financially, intellectually, spiritually — what's the value? Often the number one thing companies care about is engagement. You know, are people coming to work and loving their job, their coworkers, their boss? And ultimately, am I lowering health care costs?"

It's notable that in America, 60 percent of people say their jobs are "bad" or "mediocre," yet most do have a job (many people have more than one). Employment is at an all time low, but rates of suicide, depression and addiction are climbing. It stands to reason that if Americans are going to work, that's one place wellness initiatives can reach them. As Goetzel told CNBC last year, "The younger workforce is beginning to ask for how their company is socially responsible, and this is one other element of that. How you treat the health of workers and the footprint in the community, and handprint on the community, has quite a bit of impact on reputation and consumer confidence, and it will become much more important."

So workplace wellness initiatives aren't just hot air. But for an entrepreneur starting out, or a small business owner looking to scale, it can be difficult to know where to start. What, in the vast array of wellness offerings, is worth the expense? Dr. Goetzel offers some suggestions for thinking about how to integrate health and wellness into your business.

Rather than a wellness program, create a culture of "total health"

Offering health insurance is only the first step. Wellness initiatives that actually work don't conceptualize their plans as a program or classify a package of offerings and perks as distinct from the actual job. They view wellness as intrinsic to the company culture. You can't expect people to get healthy when you mandate unreasonable hours or excessive levels of output. You can't simply offer employees one-time health assessments and leave it at that. And you can't just pay for a health plan and direct employees to the website, to navigate on their own. Goetzel says that if you actually want healthy employees, you have to consider every aspect of their well-being: physical, emotional, intellectual, financial, social, spiritual. (He clarifies: "Spiritual to some people means religion, but to others it means having a sense of purpose or mission in life and asking, "Can all aspects of my life align with that mission?'"). Goetzel says it's easiest to think of structuring wellness initiatives into "three broad categories: policies, programs and environmental supports."

To create a comprehensive culture of health, "policies" function as guidelines, like flexible scheduling and parental leave, or feedback processes that give workers a sense of agency. "Programs" are optional perks like financial incentives for health goals or even classes (cooking, exercise, tech tutoring, etc.) and professional services offered (nutritionists, chronic disease specialists, financial advisors, etc.). And "environment" refers to the effort made by an employer to surround workers with healthy options: water versus soda, stairs versus elevators, natural light versus artificial light and so forth.

Lead by example

It starts at the top. Leadership commitment is the first step in taking a culture of wellness from theory to reality. And one of the biggest ways a boss can foster a healthy culture is by encouraging workers' quality of life outside of work. "If the leader is sending emails at 4:00 in the morning, saying, "I need you to do this by 6:00 a.m.,' that's not good," Goetzel says. "Whereas I know it's true for me that when a boss walks around the office at 6pm and says, "Hey everybody, 6:00 — go home to your family, go home to your friends, get out of here. If you need to show up tomorrow morning bright and early to finish this, that's fine. Do your work. But right now it's your time.' A boss who sets that kind of tone makes a difference."

Incorporate feedback from the beginning

Communication is absolutely essential in making sure that health initiatives are well-received and helping who they're intended to help. For small businesses in particular, Goetzel recommends simply asking employees what they need. "The first thing you want to do is get baseline data," he says. "Figure out what you and your workers would like to know about. Is it how to prepare healthy meals? Is it how to get a good workout? Is it how to manage your stress, how to meditate? Do they want yoga sessions or do they want aerobic exercise? So before you even introduce a program, go around, talk to people individually, in groups, or even in surveys. Then that can be the foundation for: "Here's what we heard from you. Here's how we're going to respond to that. And here are the steps we can take.'"

To that point, Goetzel advises not to stop communicating and evaluating, by whatever means you can. "With small companies, quite honestly, they can't afford big studies. You know, we do a lot of very large studies for large companies. But just having qualitative data… "What do you think of the program? How satisfied are you with its offering? What would you change? Does it improve your morale? Does it improve your satisfaction working here? You know, if you had another job offer tomorrow, would you take it?' Those kinds of questions, I think, are meaningful."

Build an environment that fosters health

Environmental influences can have a sizeable impact on people's moods and decisions. A healthy workplace is made up of lots of small choices. "Obvious policies are things like "no smoking,'" Goetzel says. "But having healthy food choices in the cafeteria and at company gatherings — in fact, making them less expensive than the unhealthy choices — is really important. One company I went to had a salad bar sitting right at the entrance of their cafeteria, and it looked delicious. You want a hamburger or cheeseburger? Well, you've got to go to the grill and wait 30 minutes for them to prepare for you. Do you have cookies at the checkout counter or fresh apples? Is it easier to get a water than a Coke?"

Giving people space and permission to move around is another of Goetzel's suggestions. If you have an outdoor campus, walking trails are fantastic. If you only have indoor space, treadmills are great. If you have stairs, Goetzel recommends making them more attractive. "Instead of having people go up and down elevators all day, open up some stairs and make them inviting with carpeting and paintings and music," he says.

Some of the most famous workplace "environments" are in Silicon Valley. But Goetzel says he doesn't usually point to the big tech companies as beacons of true corporate wellness because the point of the perks is often to keep people at work longer — and that's a mentality we need to move away from.

"I visited Google and, you know, it's like Disneyland," he said. "It's paradise. They've got massages and fitness centers with classes going on all the time. They've got bicycle rides. They have free food, smoothies. But people also work their asses off — largely because they're brilliant and they love doing it. But eventually it does burn them out."

Still, there is one buzzy workplace trend that Goetzel approves of: nap rooms. "There are now large companies offering napping rooms or meditation rooms for their workers, and I'm a big proponent. Taking a 30-minute break absolutely makes sense, especially in safety-sensitive occupations like medicine or transportation. But even for a stockbroker or a journalist, you know, a half hour break is probably going to boost your productivity." He reiterates, however, that sanctioning naps shouldn't be contingent on workers getting in at 6 a.m. and leaving at 9 p.m. "You have to give people a sense of work-life balance."

Choose outside vendors carefully, and stay involved every step of the way

There's an endless variety of health services that you could offer to your employees to build a wellness culture. But Goetzel says you can't just cobble together a network of outside vendors — e.g. lifestyle coaches, financial advisers, nurse lines, disability managers, conflict negotiation experts, worker's compensation specialists and so on — and then walk away. Disparate vendors can easily overlap in their services or fail to see the larger organizational problems at the root of the symptoms they're treating.

If you decide to hire an all-inclusive health plan provider, make sure they bring the receipts. "My advice would be to go to a player out there who has a track record," says Goetzel. "They've been around, have good references. Can they actually show data that they've made a difference? They can have the most beautiful brochures, but that just means they have a great marketing department. If nobody's using your service and if nobody's actually getting any healthier, why bother?"

Once you've chosen a provider, Goetzel says, that's just the beginning of the journey. "For small companies, I would go to the health plan first," he says, "but know that they're going to be, quite honestly, very superficial and transactional and they may not know what is needed for your particular company. You have to keep skin in the game. You can't just hand off to a vendor, whether it's a health plan or anybody else, and say, "Make my people healthy.' You can't say, "Call me when you're done.'