Evaluation of the Wellbeing Premium Programme

Background

Good employee health and wellbeing is of key importance to employers and the economy. Yet, many businesses find it hard to invest in the health and wellbeing of their employees, or do not invest at all. These problems are especially true for small and medium size enterprises (SMEs). There has been considerable interest in the effect of financial incentives to stimulate change in the workplace environment but evidence is limited.

The West Midlands Combined Authority (WMCA) ran a randomised controlled trial of a financial incentive programme to improve employee health and wellbeing in SMEs in the West Midlands.

How did we help?

RAND Europe and the University of Warwick were commissioned by the WMCA to conduct an evaluation of the Wellbeing Premium Programme. The primary aim of the study was to establish whether SMEs will improve their health and wellbeing and achieve higher employee awareness and participation in response to a financial incentive offer. The evaluation also aimed to assess whether such premiums help and motivate SMEs to overcome barriers when aiming to improve the wellbeing of their employees.

This study included:

• A recruitment evaluation carried out by RAND Europe in order to better understand reasons behind companies’ decisions to participate in the programme, as well as barriers, motivators and enablers that influence the success or otherwise of recruitment to the programme. Data collection involved short telephone interviews with non-participating organisations.
• A process evaluation carried out by RAND Europe and the University of Warwick in order to explain how the programme was implemented and to understand why behavioural change did or did not take place as expected within participating SMEs. Data collection involved telephone and face-to-face interviews with employers and employees participating in the trial.
• An impact evaluation carried out by the University of Warwick in order to measure the efficacy of the programme.

Methodology

This study includes:

• A recruitment evaluation carried out by RAND Europe in order to better understand reasons behind companies’ decisions to participate in the programme, as well as barriers, motivators and enablers that influence the success or otherwise of recruitment to the programme. Data collection will involve short telephone interviews with non-participating organisations.
• A process evaluation carried out by RAND Europe and the University of Warwick in order to explain how the programme was implemented and to understand why behavioural change did or did not take place as expected within participating SMEs. Data collection will involve telephone and face-to-face interviews with employers and employees participating in the trial.
• An impact evaluation to be carried out by the University of Warwick in order to measure the efficacy of the programme.

What did we find?

Findings from the recruitment evaluation

• The evaluation of efforts to recruit SMEs to the Wellbeing Premium Programme run in the West Midlands resulted in the following findings:
• Administrative burden: The views were split between SMEs in terms of viewing additional administrative burden as an obstacle to participate. Similarly, time required from staff to take up health and wellbeing activities was cited as an obstacle for some organisations.
• Trial arm allocation and research design: Uncertainty related to random allocation to trial arms seemed to have played a role for some organisations in making their decision to participate. Most SMEs were unconcerned about access to data, confidentiality or consent processes.
• Uncertainty on requirements: Uncertainty about what exactly was required and how the programme would work was one of the major factors that played a role in organisations' decision to not participate. In particular, SMEs wished that information about the programme was clearer about expected benefits, costs involved and requirements for taking part. A one-page summary of this information would be helpful for many.
• Capacity and time: Nearly all interviewees cited capacity and time constraints as reason for not participating.
• Participation in other schemes: Participation in another scheme (or satisfaction with the existing health and wellbeing offer) was cited by some SMEs as a reason for not taking part.

Findings from the process and impact evaluation

• Providing the monetary incentive had some benefits and changed employer behaviour: this was in the group that received the high incentive. Employees in SMEs that received the high incentive reported that their employers had:
  • Done something concrete to improve the health and wellbeing of employees, such as providing training on health and wellbeing.
  • Made information and services available to improve their mental, physical and lifestyle health.
• Workplaces receiving a high incentive were also more likely to attend the network meetings and spend the incentive. SMEs could decide how to spend the incentive; ways in which the incentive was spent included:
  • Paying for employee time to put the ‘Thrive at Work’ Programme into practice
  • Paying for employee training
  • Giving incentives to individual employees, for example, by subsidising their gym memberships
  • Providing additional services, such as consultancy to improve health and wellbeing policies in the workplace
  • Making changes to workplace facilities such as canteens, changing rooms or showers
  • Buying new equipment such as vending machines and water bottles.
• The monetary incentive did not result in behaviour change among employees. Some employees in SMEs that received a high monetary incentive reported that they intended to improve their physical health relating to their muscles and their joints, but this does not necessarily mean that a change in behaviour took place. This may be due to a number of reasons (e.g. lack of time, insufficient level to change behaviour, insufficient time to see the change).
• The programme was generally well received and things got better over time: Employees from SMEs in all groups reported benefits of being part of a programme designed to improve their health and wellbeing. Employees reported that employers that signed up to the programme:
  • Took positive actions to improve the health and wellbeing of employees; and
  • Provided information, put on activities and increased services for employees to improve their health and wellbeing.
• Employees also made more of an effort to improve their physical health (e.g. muscles, joints) over time.
• Larger SMEs did better than smaller SMEs: Employees working in larger SMEs were more likely to report that their organisations provided information, put on activities and provided services designed to improve the health and wellbeing of staff. Employees working in larger SMEs also reported that they were more likely to try to improve their physical health relating to their joints and muscles.

What can be done?

Recommendations from the recruitment evaluation

• Conduct market research with SMEs to explore how to approach them and if and how they would like to participate in a future initiative.
• Complete the design of the intervention and evaluation before starting the recruitment in order to formulate a clear business proposition.
• Rely on pre-existing connections of your team and/or established business networks and personalise messages when speaking with SMEs, building on existing relations and trust.

Key messages from the process and impact evaluation for policymakers

• Monetary incentives can help employers change what they do (if they are high enough)
• Monetary incentives was not a key motivating factor for SMEs to sign up to the programme and thus it may not be essential
• Implementing incentive programmes for SMEs takes time and resources and regardless of how motivated an organisation is to implement strategies to improve employee health and wellbeing, business operations sometimes take priority over staff welfare initiatives
• Offering flexibility in programmes such as ‘Wellbeing Premium’ can be a strength and a weakness: SMEs could choose areas of focus (e.g. mental health) allowing employers to tailor initiatives to the profile of their workforce, but it was more challenging for them to share resources and learn from each other
• Understanding the programme is crucial for success: effort should be made at the start to explain the programme and resources available to all staff in an organisation.