Hamad Medical Corporation (HMC) is taking on a huge wellbeing challenge. As the primary provider of secondary and tertiary healthcare in Qatar, HMC and its 25,000 staff carry a significant responsibility for the health of others. With three new hospitals soon to be added to the nine already under management, the country’s biggest employer is about to get bigger, and its HR team wants to ensure that everyone is well looked after, both in their jobs and beyond.

A coordinated and integrated employee wellbeing programme on this scale is a massive undertaking. Like other local organisations investing in the wellbeing of their people, HMC is in the early stages of feeling out what will work and, crucially, what employees want.

“We completed a unique assessment within the business to make sure that what we’re doing is what people actually need,” says Ms Fatima Haidar, chief human resources officer. “We are really focused on getting input from employees across the business, making sure they are involved in steering the project.”

Patient-facing staff can have some of the toughest jobs going, so HMC aims to ensure the right support structures are in place. This includes keeping administration to a minimum outside core work, making all HR services available online and running a dedicated staff clinic to tend to employee medical needs. That so many of the people HMC caters for are directly involved in caring for patients is a pivotal business performance challenge. “When you are faced with stressful clinical work, you are obviously more likely to put patient needs in front of your own,” says Ms Haidar. “In HR, our number one goal is to make sure the people who are in front of the patients every day get the support they need. Healthy employees create a healthy organisation and patients will benefit from this.”

As HMC develops its wellbeing strategy, it will help people with their fitness and nutrition, and take heed of their professional development requirements – better communication skills among managers boosts workers’ wellbeing – and spiritual needs, a factor Ms Haidar describes as ‘central’. The programme will break the whole issue into three streams – organisational health, occupational health and individual health – each of which will be tackled in a data-driven way. “We’re already doing a lot of work in these areas, so the first exercise is to set a benchmark on what we are doing now, and how effective it is, to make sure it works as a coherent strategy,” she says. “Then we will be able to set realistic KPIs and measure ourselves against those. As a government organisation, we are very aware of our responsibility to ensure we are maximising every riyal we spend in the best possible way. That means we have to be working effectively and efficiently 24 hours a day, seven days a week – and to do that, having a healthy workforce is critical.”

That a medical organisation is taking the lead on a holistic view of wellbeing should not be a surprise. The surprise is that relatively few business leaders feel compelled to follow their lead, because wellbeing is becoming a macro issue.

The GCC region has some of the highest rates of obesity in the world – a 2014 report by medical journal The Lancet found obesity rates at double digits across all six Gulf states – and it fares little better in diabetes, with data from the International Diabetes Federation pointing to the disease afflicting 23.9 per cent of the adult population in Saudi Arabia, 23.1 per cent in Kuwait and 19.8 per cent in Qatar, compared to a global average of 8.3 per cent.

Employers stand to be among the biggest losers if these public health concerns continue to worsen, courtesy of increased sick days and rising health insurance premiums, pushed up by the cost of managing chronic conditions. This makes workplaces one of the new frontlines in the war against the waistline – a point not missed by insurers, which have gone on record suggesting employers need to take the initiative to help their insured staff get healthier if they want to control premium costs.

Wellbeing, in this way, can be described as a moral imperative – taking a holistic view of health is simply the right thing to do as a good employer – but there is also a cold, hard business case that you get more out of people when they feel at their best.

“It used to be that businesses saw wellbeing as a soft, fuzzy thing at best,” says Professor Sir Cary Cooper, psychologist, president of the CIPD and one of the world’s leading authorities on workplace wellbeing. A turning point in this attitude came in the aftermath of the global recession, when one of the driving forces in many countries was the public sector, which had to act to reduce epidemic levels of stress to increase productivity.

“Lots of organisations in the private sector, meanwhile, see turnover as the issue that forces them to look at this,” says Cooper. “They became so mean and lean that if they lost any more people, they simply wouldn’t be able to carry on. They needed a strategic approach to wellbeing – and, beyond that, they needed to create a wellbeing culture.

“A wellbeing culture helps reduce stress-related sickness, and in particular presenteeism – which can cost twice as much as absenteeism. It also enhances productivity; it’s no surprise to discover that healthy employees produce more.”

Cooper outlines the components he believes make up a wellbeing culture: socially, emotionally skilled line managers; wellbeing audits to find out where the problems lie; employee assistance programmes for those who aren’t coping; and flexible working. The return on investment comes in a reduction in stress-related sickness and enhanced productivity: unsurprisingly, healthy employees produce more. “Line managers are a critical component here,” says Cooper. “We just don’t have the middle managers to manage people in the new economy, where we’re doing more with fewer people. They need good interpersonal skills – the ‘soft’ skills people always talk about.”

Other challenges include beating the mindset that working long hours means you are more effective and productive. From a wellbeing point of view, Cooper believes companies should let people work flexibly if they can. “Most of our jobs aren’t in manufacturing now, so there’s no reason that we can’t, and even in manufacturing it is possible to allow people to work flexibly if you manage it.”

While we might view wellbeing as primarily a reactive discipline – for example, by looking after staff suffering from long-term conditions – being proactive about issues like flexible working is just one tool employers could deploy to tackle underlying issues that negatively affect wellbeing. Whether it’s used to take the stress out of coping with sick children, avoid the rush hour or just get to the gym, it is a zero-to-low-cost change that can have a big psychological benefit, including boosting perceived trust (when US university MIT introduced flexible working, 62 per cent of staff reported an ‘improved feeling of trust and respect’).

For international payments company Mastercard, taking a flexible working approach has been one of the key changes to the way it manages people. “We’ve reviewed some of our policies that play in the wellbeing space and now espouse a flexible working culture,” says Scott Tierney, Mastercard’s senior vice president of human resources for the Middle East and Africa. “People are much freer to choose their working hours, patterns and locations. We’re very amenable now to people working from home for parts of days or whole days. It could be for business or personal reasons.”

Taking this approach to measuring performance via output, rather than time in the office, is part of a suite of changes aimed at improving the lives of employees. Others include a review of leave policies that saw a global minimum of four months’ maternity leave introduced in any region that didn’t mandate more. In the Middle East, this amounts to a huge increase, well above most legal requirements, and it was accompanied by a boost to paternity leave, which rose from five days to eight weeks overnight, with flexibility built into how that leave can be taken. “The maternity/paternity leave policy had a hugely positive impact in our part of the world, where market practice is generally still quite basic,” says Tierney.

More directly linked to health and wellbeing is Mastercard’s health insurance in the UAE. Tierney says the cover it offers its team is both broad and deep, and cites instances where it has been fine-tuned to the needs of the team at little additional cost in terms of annual premiums.

Regulations around health insurance have been gradually strengthening since 2006, when Saudi Arabia was the first Gulf state to make it mandatory for expatriates. Since then, other nations have been phasing in similar rules, with late December seeing Dubai extend a deadline for companies to provide essential cover to employees, to cope with a last-minute surge in applications. GCC governments are keen to increase healthcare expenditure while getting it off their books and into the private sector. According to a report from Alpen Capital, GCC governments funded 70.3 per cent of total healthcare spending in 2013, higher than the 60 per cent average around the world. It’s important to remember, too, that healthcare expenditure in the GCC currently tracks behind the global average, running at 3.1 per cent of GDP compared to 10 per cent.

As the population grows and healthcare improves, the rising costs of provision, especially for expatriate workers, will be pushed on to the private sector. Already, regulations around health insurance are continuing their phased movement toward greater stringency, and the cost of premiums – often beyond the means of low-wage employees – will fall on employers. Premiums could then become a very real and measurable wellbeing indicator, especially for larger organisations. Equally, prospective employees, especially those with families, could see good healthcare provision as a deal-breaker, prioritising companies with good health and wellbeing benefits in the job hunt.

At Mashreq Bank, which introduced a comprehensive approach to wellbeing a little less than two years ago, early indicators are that the programme will have a positive financial impact, as well as improve the health of employees. “We are starting to see the kind of bottom line impact that we predicted in terms of premiums paid, but we expect this to increase significantly with time,” says Ashok Gopal, head of talent management. “Now, we’ve impacted a significant part of the organisation; as we reach more people, the bottom line impact can only increase.”

Mashreq’s award-winning programme was developed after considerable research, during which it became apparent that typical approaches were based around single events, rather than long-term sustainable change. “Programmes that existed only focused on one part, typically the physical, rather than taking a comprehensive view of wellbeing,” says Gopal. “Research of the market told us things we could learn and incorporate, but there was a lot more where we would have to start from scratch.”

The result was the bank’s own creation intended to take care of wellbeing by focusing on three elements: eat, move and sleep. It set out to tackle nutritional choices and make healthy options available, encourage activity and exercise, and diminish the ‘macho’ status accorded to those who get by with little sleep.

The aim was to encourage the entire company to be engaged with the issue of personal wellbeing. “At a time when organisations were cutting back on costs, we invested a lot in our wellbeing programme,” says Gopal. “We were trying to do all the kinds of things that would promote change; we wanted people to experience change so they would become hooked. They would, of their own accord, do things that would impact their own wellness. We wanted to make the activities long enough for people to experience that impact and be motivated to make it part of their lifestyle.”

This approach saw the company deploy the power of competition and teamwork to encourage more walking, via a three-week step challenge, for example. A ‘buddy up’ scheme was introduced in the gym, where people worked together over a month. Other initiatives included flu vaccines for all staff, while lunchtime sessions from nutritionists emphasised the right eating decisions and small sub-groups with particular needs – such as diabetes management – were given special attention. Ultimately, though, all these efforts still come down to individuals.

“Perhaps most importantly, wellbeing started to become part of the organisational vocabulary,” says Gopal. “It is safe to say that irrespective of their current state of wellbeing, a big chunk of people are paying much greater attention to their wellbeing. Our target is to make sure every employee sees a focus on wellbeing as being part of their contract [with the bank] – not legal, but almost a psychological contract.”

But while plenty of businesses are increasing the focus on physical health, the same cannot always be said of mental health. This remains an issue that is much less talked about, partly because of the historical social stigma attached to the impact of stress and depression. But there are other issues too. “One of the other reasons perhaps it’s neglected is that there really isn’t the capacity to deliver programmes targeting the more psychological aspects of wellbeing… the preventative interventions that focus on shaping and changing the way people think or look at the world, such as resilience training and stress management. It’s a really big piece to overlook,” says Dr Justin Thomas, associate professor of psychology at the UAE’s Zayed University.

Thomas suggests this is partly down to the tension that exists for any organisation that offers to help staff deal with stress, because it is in part an admission that its workforce is stressed.

This is misplaced, says Thomas, who argues that stress is a natural phenomenon and that there is never going to be a stress-free workplace. “I think the best thing to do is acknowledge that some people will find certain situations stressful and ensure that the workforce is kitted out with the cognitive resources to deal with those situations when they arise,” he says.

That might mean training in the techniques of mindfulness, which at its heart is not about avoiding stress but rather changing our relationship with it and the types of thoughts we have when stressed.

“It isn’t the stress itself, it’s what we call the secondary stress, our response to the primary stress that gives rise to additional stress,” explains Thomas. “There will always be people who say things or do things that we interpret in such a way that it gives rise to negative emotions in us.” The idea of resilience teaches people how they can respond rather than react. It lies at the heart of mindfulness, which is why it has become almost an industry standard for forward-looking companies that are trying to empower their employees to better manage stress in the workplace and outside it.

“It takes practice,” he says. “It’s easy to talk about it, but it’s a very different thing to do it, so a big part of mindfulness is really about cultivating those abilities. Employers that appreciate the benefit will carve out the time for employees to take on board those abilities.”

To make it happen, Thomas says there need to be more role models in workplaces who are less stress-reactive and instead show how to behave in patient and compassionate ways, even when there are the external pressures that trigger stress. This echoes Cooper’s concerns about the shortfall of talented middle managers armed with the necessary soft skills. It is also necessary to combat the emerging epidemic of ‘presenteeism’, which, says Thomas, sees people who are not ‘firing on all cylinders’ drag themselves into work every day, where they end up having a more negative impact on an organisation.

“As a holistic package, taking care of psychological wellbeing is money well spent,” says Thomas. “It really does save in the long term, but it’s not just an economic concern. If employers are concerned about other human beings, about how respectful and purposeful and engaged they feel with their world of work, those psychological variables are all really important for a good employer to get right.”

The last word, fittingly, goes to Cooper, who has seen businesses finally wake up to a message he has been extolling for years. “From an HR perspective, the wellbeing agenda is critical to talent retention and attraction,” he says. “Organisations that create a wellbeing culture, where people feel valued and trusted, have manageable workloads, realistic deadlines and good work-life balance and are managed by praise and reward rather than fault-finding. They are more job-satisfied, healthier, perform better, are committed and will go the ‘extra mile’ to deliver a quality product or service.

“It is our duty in HR to create this kind of culture, and it is within our ultimate mission.”

Why competition works

Your investment in wellbeing will only pay off if employees are sufficiently engaged with the idea to get involved. But rather than appealing to their self-interest or their desire to contribute to the greater corporate good, what if the answer to making wellbeing work was the desire to beat the colleague next to you?

Multinational companies are increasingly tapping into the competitive streak, by setting up challenges that pit staff against each other. That could mean competing to stop smoking fastest or clock up the most miles on an exercise bike, or it could mean using wearable technology to create ‘league tables’ of employees who walk the most.

Technology firm Flabuless is using the idea to push traditional corporate wellness programmes beyond gym memberships and exercise classes into a more sustainable future.

“It works like a frequent flyer programme, where you earn points based on how healthy and active you are,” says co-founder Jaya Maru.

While rewards for good behaviour are key, it is competition that has driven engagement, encouraged by video-game style features in an app – known as gamification – that can pit one department against another in a quest for rewards, rankings and reputation.

And there’s a sensible rationale for addressing the issue: a 2015 survey by Oman Insurance Company and health specialist Bupa indicated that 89 per cent of UAE consumers want to live a healthier life, while 58 per cent said work commitments were the main barrier to doing so.