Fit for Duty podcast: Episode 5.

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Hello and welcome to the fifth episode of the Fit For Duty Podcast. Today we’ll be discussing whether workplace technology is keeping us healthy or making us ill and helping business leaders recognise and seize a once in a lifetime opportunity. I’m Lorien Norden, Content Strategy lead for Aetna International, and I will be joined by Vice President of Customer Proposition Caroline Payne, and Dr. Hemal Desai Global Medical Director. In March 2020, just as the coronavirus was reaching pandemic levels, we conducted a global survey, the results have given. The results, which are published online, have given rise to this fascinating discussion.

Over the course of an hour, we dig into the Sybase findings, discussing how we want the future of workplace wellness to look and the impact of technology on employee health and well-being. The discussion also covers changes taking place and attitudes and regulations around technological health and well-being interventions, such as virtual health. The challenges to employee work-life balance, and the importance of humanity trust and compassion in corporate culture. We cover what organisational frameworks could look like as we continue to adapt to mass remote working, and we also investigate how organisations can capitalise on employees’ appetites for access to digital health tools that genuinely reflect their needs. We hope you enjoy the episode, and don't forget you can subscribe to the podcast.

(1:41) Hello Caroline, hello Hemal. I'm delighted you could join me today to discuss digital health dilemmas, and those that are facing today's organisations. Could I ask you to please introduce yourself Caroline?

Yes Hi, good morning Lorien. My name is Caroline Pain, I run a function called customer proposition here at Aetna International. I've been with the company just approaching eight years. I've spent my 25-year career, which is a bit scary, in insurance, and my particular passions are around customer experience and digital technology, and how it has the potential to help shape future wellness. So thank you very much for the invitation looking forward to the rest of our conversation.

Hi Lorien, Yes, my name is Hemal Desai, and I'm one of the global medical directors in Aetna International, and my scope of activities include looking after some of our medical affairs through our healthcare businesses and digital health services such as vHealth. And I'm delighted to be here.

Wonderful, thank you and obviously both have very significant roles in the business I really appreciate you making time to go through this topic with us today. I mean it's a fascinating one, our Digital Health Dilemma campaign has looked at how technology is changing our approach to physical and mental health, including the benefits and drawbacks of technology, largely in the workplace, but also at home, and never before has the topic or the opportunities created by technology been more relevant as so much of the global workforce is continuing to work from home and businesses are being forced to adapt their physical health and their mental health support for employees accordingly. So, the area that I really wanted to touch on first of all with you this morning is, as an organisation, as employees ourselves, how do we want the future of workplace wellness to look? And how can we work towards helping our customers from an international perspective, bring it to life? So Caroline Could I ask you, you know, what are your thoughts on that first and foremost, please.

Sure sir. So, in my view, I think, you know, the future of workplace wellness has to be directed by the employee, by the individual. I think organisations and those supporting those organisations need to be able to build technology and other forms of support that meet the employee where they are. And the reason I say that is because we know that individual responses to crises such as COVID-19, but, but also, general trauma and challenges in life are shaped by a multitude of variables so: could be family circumstances the quality of their relationships. It could be their physiological response to stressors, it could be their living conditions, the state of their financial affairs the physical health, even in some cases genetics, where there are kind of particular indications around depression or addictive behaviours, for example. So, for me, the closer that the help gets to the user, the better. And this makes the digital and physical support services together, the combination of those, so powerful. And I think we're going to see with, with the recent experience of COVID that more health delivery will actually be done digitally in the future. And I think, you know, importantly, there are lots of different paths that employees have in order to get help so that a lot of them start online we know this so Dr Google, as one example and then they may reach out for individualised support, so it makes it really critical that the resources that the likes of insurance companies offer are both credible - and so that's clinically credible and I'm sure Hemal will have something to say about that too — but also have some triage capability, so that people are not just left in a situation. So I think for me, the more employers and brokers encourage employees to engage with services, the more will actually be able to offer that individualised help for them in the situation that they find themselves in.

And I would just say as well that there are no shortage of solutions out there. Lots and lots of help, but just as we know that patients may work their way through two or three antidepressants before they find one that works and suits them, so, the same holds true really for well-being there isn't a silver bullet. There are a multitude of potential solutions that will suit people depending on the points that I noted above, and I think in terms of what the employers should be encouraged to do is really to work to work to stigmatise well-being and also where people find themselves in difficult situations. So, we know that employees find it very personal, we know that employees don't always want to share with their employer. So again it’s about the employer there and opening up, sharing stories wherte possible sharing some of that vulnerability and encouraging employees to use the services that are available to them.

Yeah, I would completely agree and Hemal, I'd be interested in your take on this as well so looking at everything that Caroline has just said there about, you know, really appreciating the holistic view of well-being and the different impacts and pressures that people are currently facing and will continue to face, and how organisations can really deliver a personalised menu of options to support people's health and well-being. What is your take on what organisations should be looking to do as far as workplace wellness is concerned?

(7:45) I think I think this is a really, you know, critical question at this time, I think we're in a at a real pivotal junction in how the workplace will function. Both now with the immediate crises, but also in the future. And I think many organisations are now looking at how they structure themselves in the future, and I think embedding work workplace wellness into that future model I think is critical and I think there's a real opportunity for employers to to revisit how they look at employee workplace wellness. So I think, I think there's a really big opportunity now, and I think that's really important for us to understand and I do think that the, you know, there is a role that everyone has to play in this. So, whether it's the employee, like Caroline said, because they play an important role in this. But the employer themselves, whether it's the brokers who are involved in looking for health benefits partners, whether it's the health benefit provider themselves, who has a lot of expertise, or should have a lot of expertise in this area, whether it's healthcare providers, both in the physical and digital space to try and create the right tools and interventions to help employers think through how they do this. I think all of those and many others will have an important role to play. And I think the role is really to start to think about this and lead by example to share evidence across workplaces to look at what's needed most promote good practice and importantly to demonstrate the impact, I think, employers, really are looking at the impact that workplace wellness can give for them and there's lots of evidence out there that you know, a well workforce is going to be a productive workforce, and it's going to drive benefits across the organisation, so that hasn't changed, but I think the workplace has changed and therefore, you know there's a lot of work to do, both from the employer point of view but also the employee point of view, around how we create that wellness culture, I guess.

(10:00) Absolutely and actually you touched on the roles of various parties and agencies in this picture. And actually, can I ask you how could you come back to maybe looking at the role of government policies and how we keep on top of changing regulations as far as employee well-being is concerned, and how do organisations then build that into what they're doing on a micro level within their own workforce?

Yeah, so I think I think government policies will change but historically government policies tend to change, in retrospect, and usually they catch up to what workplace requirements are so, I think, even though governments are thinking about this moment, I think. Generally, the direction of travel has been positive and there have been more guidance and regulation that is coming into force across the world, to encourage employers or to force employers to think about the wellness of their population. Generally, it tends to be on the health and safety environment rather than wellness as a holistic driver of productivity. And so really I see organisations leading this and we already see in the workplace that some organisations are better than others. And I think the most important thing is to recognise for organisations that employee health and well-being is important for your organisation. And I think once that penny has dropped there is there is so much that organisations can do and not leave it to government policy and regulatory environment to make that happen. I think it's also important for organisations to self-reflect and understand their own needs better and the needs of their employees in a very open and transparent way, physical health has really led the example in that but mental health is still a big challenge in many parts of the world and then many organisations across the world. And so trying to understand how physical and mental health issues affect your own workplace and your, your own workforce. I think becomes the first step in this. And then, and then addressing that a matching that as Caroline said earlier, the plethora of interventions that are out there, I think, will then be much more beneficial for organisations. So, I think gathering the evidence, designing the right programme, working with the stakeholders, working with the people who are experts in this area who can pull together these things for organisations, I think is quite important. But, if you understand the need, then your solutions can address that need and I guess that's the key point to make.

(12:51) And, Again, Caroline, like to come back to a point that you made earlier and you spoken about learning lessons and when we look at regulations across the globe as well how quickly regulatory bodies have opened up the scope for virtual health and consultations both to benefit individuals from a mental and a physical well-being perspective, what are the other lessons that you think that society has learned in, you know, as a whole, from the whole kind of COVID pandemic experience and how can we carry that forward with us?

(13:30) Goodness. That's a wide-ranging question. And I suppose you know we're still in the situation. So, you know, not quite sure because it's a rather open-ended situation we're not quite sure when we'll be able to really look back and reflect upon the seismic changes that may well have occurred. You know, sitting a period of a few months from the onset of the pandemic I think, I think we may be seeing a re-emergence of more collectivist society. But in terms of the sort of solutions that are needed to support people I think we're going to see organisations and hopefully governments as well. Creating far more ability to individualise those solutions and make things personal to people so I said before about, you have to meet people where they are. And you have to understand the full context of their lives before you offer up potential solutions that may help so I think you know there may have been some underlying shift in values over the period, I think, is society becoming more caring? It's difficult to tell because there are some real polarised views and there have been, you know, some very public differences that have been aired in the last couple of months. Outside of anything covered related as we know. So, I don't know, it's the honest answer, Lauren because I think we're too soon into this process and the set of changes to really be able to tell what's going to happen to society but certainly from an organisational perspective I feel more qualified to talk about that and I think what we've seen there is a real genuine effort by organisations to provide support to employees you know there's some research that was out just this weekend showing about 80% of employees feel that their employer has handled this crisis well, and has provided the right support for them. You know that won't be universal of course, and there are going to be very difficult times ahead. But I do think organisations have really swung into, you know set of actions that feel as though they are listening to employees that they have really changed the view, the mindset towards remote working they have facilitated fast dispatch of equipment in many cases to support their employees. Many employers have sets up or provided access to support for both physical virtual mental health. All of these types of support services during this time. So I think, I think we've certainly seen the re-emergence maybe have a slightly more patriarchal feel in organisations - really looking after and feeling the burden and the responsibility of care for their employees at this time. It's been a very traumatic time for a lot of people who are suddenly just juggling multiple roles in ways that they haven't had to before, for example home schooling and child care and the health of elderly relatives, for example, all of these loomed large in many people's lives and I think in general, what we see as organizations have risen really well to the challenge. It's just too soon for me to talk about whether that changes society, or government policy in any real meaningful long-term way. But those are.

(17:19) Just on government policies and changing regulation I think you make a very important point. So, where, where governments, move quite fast is around the adoption, or encouraging the adoption of virtual, I guess healthcare services. We've seen in many places around the world that where regulation was a barrier in this this barrier has been dropped by many governments or regulatory authorities, for example, in the UAE, in Dubai. We run a service and that service wasn't able to do a video consultations, or wasn't able to work for us we weren't able to work from home, due to regulatory challenges, but that was quickly changed and seen as a barrier by health authorities, so that that could be enabled and that has resulted not just in in our services being able to meet the needs of people, but also across the whole of the Emirates and I think that's been a real positive change. And hopefully governments and regulators will see the need for that, and many have reduced some of the administrative burden around healthcare services across the world and I think that that will hopefully stand us in good stead and it'll be interesting to see how that develops over time and whether some of that rebalances and more regulatory barriers than get put back into place once we're out the other end.

(18:37) Yeah Just going to agree with, with Hemal there and just say I think the real test of this will be one way or two, three years remote hopefully from the sort of dying out of this pandemic and seeing which of those changes are sustainable, you know, for example, there's been some movement in the US around delivery of more services, health services, that would previously have been physical delivery only into a virtual environment. We've seen the advent and the real growth around things like virtual physiotherapy and we know that MSK claims are you know amongst the highest in most insurance companies’ books. And so if there are good solutions that can be delivered virtually and consumers want to use them and they get clinical benefit from doing so. I think the key test then will be government's then you know as Hemal said, be able to tick the box and say actually these are good for the long term? And I think we may see then, even more engagement from customers patients rather earlier on in the process, in the preventative sphere rather than necessarily the, the treatment of acute and chronic conditions so I think it would be really interesting to see how this develops over time.

(19:59) You mentioned MSK there as musculoskeletal conditions for anybody who's not familiar with the MSK acronym. But I completely hear you and I think that a lot of what we're talking about in terms of those regulations, and regulations are in part set up to one protect people, but potentially it's that extension of trust and putting the onus on organisations to make sure that they are protecting their customers their members their employees. So it's shifting  that responsibility for trust into the hands of the organisation or the provider and I think we have seen a lot of trust, compassion humanity, coming back into the business world, where perhaps if you were being cynical about it you could say that it's been eroded some often over the years. And would you agree with me Caroline on that. Do you think that trust humanity, compassion, we are going to see more of those in the way that organisations conduct themselves in the future?

(21:06) Yeah, I do actually there's, there's a pretty significant body of research evidence around the power of the, what they call the feminization of leadership. You know, not putting this into a gender box, but actually really it's about those very human and very personal values being brought to bear in the way an organisation governs itself. And, I think there's also a lot of evidence around vulnerability and the power of vulnerability and leadership and I think you know the values that you've described are increasingly requirements of a leader, and they're also increasingly requirements around how people expect businesses to conduct themselves. We've seen a real growth in the investment marketplace around, buying shares in companies that have, or seen to have ethical policies for example so I do think things are changing. And if I reflect on my own style, you know these are values I hold really dear as well because I think in my role, it helps me do my role better. It makes me think of the customer first it makes me relate to my team better. I think there are real advantages around asking and listening. So, listening more than talking. For me remoteness doesn't need to equal remote as an employer and as a leader. I think you know what we've seen and I did mention this a couple of minutes ago was that we're really seeing that growth and individualised support and real care being shown so there's a whole piece around when you ask somebody how they are, Instead of that, rather, kind of, you know, just ‘Yes, I'm fine’. And then you move on with the work of the day you actually are listening to how people are responding to that question so for me this move to, to virtual working. And I think this might actually also hold true for virtual healthcare delivery as well, it allows people the space to really ask and really listen to the answer. We've seen lots of research as well Lorien, you know, the majority of people don't want life to just resume, the way that it was before that are changes that people want to see. And I think, we've seen some of the best of humankind. During this this rather tumultuous few months and we've also seen sadly some of the worst of humankind as well. But I do think what will emerge is that these values will take priority, I think people who innately will trust and want to invest in businesses that have done the right thing. During this this this whole process. Whether that's the right thing for their customer or for their employees, lots and lots of examples of that. And I do think that research supports the argument as an individual in a business. These values are super important.

(24:09) And Hemal, from the perspective of a clinician, going back to your days as understanding how to deliver bedside manner, how to build compassion and humanity into what you do, you know, in the medical world, and then looking through to the organisation and the purpose that we have helping people on their path to better health and seeing the shift and supporting the shift away from sick care to health care to really enabling people to live the best lives that they possibly can. What does trust compassion and humanity mean to you?

Well, I think, you've encapsulated it quite well and I think Caroline touched on this, I think, You know, we're going through unprecedented times at the moment, and it's putting immense strain on us as individuals, on our family units on our work colleagues and on organisations whether they're big or small. And leadership is being tested in a way that it's never been tested before, and everybody is watching how leaders and businesses are operating at this time, and how they look after their employees as well as their customers. Because as Caroline said this time can bring out the best in you, but it can also bring out the worst. And that's not just as individuals, but that's also as organisations, and I think people will judge who they purchase from in the future and who they interact with on the basis of some of the things that they've done during these very difficult times, for people and I think this is again yet to play out and as Caroline said some of that evidence has already been shown through investors and others in terms of that ethical approach compassion humanity trust, all of those aspects. But I think the important aspect is, you know, how we treat people and how we use human connection, even in a virtual world, to be able to help and support, but also be able to deliver what we need to do. And nobody has been through anything like this before. And we're all learning to cope with it together, and the power of the human connection, whether it's an individual level in an organisation or whether it's in the higher levels of the leadership group. It's really important that that those human connections remain. There's an increasing body of evidence around the one-to-one interactions and how those in middle management level, and beyond, is proving to be quite beneficial and organisations where there's one-to-one interactions are taking place people are asking how people feel how they are and genuinely asking is creating better working cultures than in those organisations that don't have that in place, it puts an immense burden on people, but we know that those human connections are really important. And again, they're important because of the need for showing compassion, and for building trust across organisations and I think this is an important facet of how to get through the current situation and beyond.

(27:16) And, and one of the things I wanted to touch on obviously is as a result of the digital health demo campaign and the survey that we have, have run and the output from that, when we're looking at the impact to individuals and how they can have again that trust placed in them to know what is best for their health or well-being, whether that's looking after, family members, etc. making sure that they are not suffering from burnout during this particular point in time, we've touched on in the survey instances are examples of workplace challenges that have been in existence for quite some time and this whole situation has really just exacerbated those. And one of the parallel or just juxtapositions that we have, we have found in our survey is that from an individual employee perspective, 74% of people agree that workplace technology, whether that's communication platforms or being provided with a company mobile phone enabled them to manage their time better, so that they could exercise more, however 70% of people also say that they wouldn't exercise more if they spent less time on their PCs or actually physically at a machine working. So, how can organisations help individuals to tackle this dilemma?

(28:47) This is the this is the classic of rational versus emotional isn't it? We all know how we're supposed to eat, we're supposed to drink. We all know we should be having eight glasses of water a day we all know that we should be eating more fruit and vegetables we also know that we should be spending less time still sitting at our desks. Lots of good intentions out there, but it's very difficult for a lot of people to translate those into action. The role that an employer can play in this is I think around role modelling, around permission around, encouraging people to build structure into their remote day. People have different, different kind of routines, don't they so there are some larks, I'm not really a lark, but I do know that if I don't exercise first thing in the day it does not happen. You know, but night owls might be better off working exercise into the day later on, so I think organisations need to allow that to happen but also to, to actually openly and transparently talk about it so that people don't feel guilty for creating some boundaries around their days. Role modelling as a leader, the practice of taking time for yourself. I think that's really important. And I also think that this kind of boundary setting is really important as well. So, you know, humans do tend to work better when we have rules and guidelines and even if those are self-imposed there is some evidence that people may well stick to them a little bit more so for example, scheduling an appointment with yourself to do something so whether it's a dog walk, whether it's a call to friend or family, whether it's a run, and make that the start of separation from the work day to the, the ‘me’ day, you know, checking the phone, you know, this is something I struggle with, personally, but, you know, when you're itching to check the phone first thing in the morning before you've barely opened your eyes, get up and do something else, just distract yourself for a few minutes, switching Wi Fi off for a couple of hours is actually quite an interesting one though I was reading some something about that this weekend that you know the emails will be there when you come back, but it gives you some mental space to not be processing them and feeling guilty about lack of response, so I think for me, what employers can do is, is role modelling, openly talking about the importance of creating structure and boundaries, and providing or giving people permission almost to be in control of their own lives. You know, we all have consciences we all know when we're not doing as much as we could be doing. And I think employers it's part of this trust, exercise, you know, it goes both ways. The more employers are able

(31:51) Hemal just building on what Caroline has said there in terms of an individual's response to having that trust to being empowered to make decisions for themselvesa and so therefore set up a schedule and a routine that is going to enable them to thrive, both physically and mentally. What kind of a response does an individual have potentially physiologically or mentally to that level of trust if it's placed in them?

Like with everything. I think people react in different ways. Some people like the rules set for them and some people like to set their own rules, within a framework and a boundary of acceptability and I think this giving permission, that Caroline talks about is quite important in this, and everybody's different, and I guess we're at the yeah we're really at the start of this journey of mass remote working and organisations are grappling with how to set the rules around that to have that trust in employees to remain productive in a remote environment and to fulfil the objectives of the organisation, whilst not being able to in inverted commas visibility having visibility of them physically, and some managers will be able to cope with that and some managers won't be able to cope with that and I think the rules of the office environment, and now the rules have a have a much wider working environment and remote working and I think we're still yet to fully develop those rules and I think that will be a mixture of organisational frameworks around flexibility. And working from home or from a remote environment, and combining that with the individuals responsibility to make sure that they can fulfil their delivery of their work through a means that remains a productive and I think though, those that that balance is really partly personal and I think partly within the organisation and the responsibilities of an organisation. But I think, setting the framework for that has really been accelerated by the covert situation where now we've got mass remote working. And I think a chunk of that will still remain over time and so there's only a small window for organisations to start to build those frameworks and those rules to be able to function productively in the future.

(34:17) And one of the areas that you touched on there again is around that that that framework and that that that organisations can provide so whilst we've discussed the individual element and individual response and what they can do. I'd like to dig in a little bit more to the organisational side. So when it comes to enabling them to better manage their health and well-being there are so many tools out there that can support individuals with their quest for better health and well-being. We know that healthcare consumers are far more sophisticated in terms of how they're using their Fitbits, how they're using their mindfulness apps, how they're planning their days they're googling their symptoms. And from our survey results, we have identified that employees are calling for more tech more digital health solutions to help them improve their own well-being and their own circumstances. So Caroline if I could ask you first you know how can organisations really capitalise on this drive this appetite for that access and how can they seize this this opportunity that is probably a once in a lifetime once in a generation opportunity.

You know, again there are some paradoxes in here because people have lots and lots of apps on their phone, many of which are never used, so I don't know whether it's the appetite for more digital and more tech that people really want. I think really what they're saying to us and to their employers is that they want access to tools that will genuinely support them. And that seem to genuinely understand them and reflect their, their needs and their situations as we as we discussed earlier. So I think it's not just about tracking more tech at the problem. It's really increasingly about mapping out individuals’ journeys and being able to personalise the delivery of care and support to them. And I think what I would say from an employer perspective is come and talk to, to those of us in the industry who have access to some fantastic solutions. And let's see if we can build those journeys out together. Then I think it's important for the employer to respect the part of the journey that the employee is in which is very personal to them. So I think this is where we get into discussions around the exchange of data, how data is reported. You know what, what's private to the individual versus what we would ask them to trust us with so that we can then deliver and build the right solutions for them. So I think, you know, honestly, I think, I don't think necessarily that the answer is lots more apps. I think it's really genuinely How do you meaningfully pull all of those solutions together, and take an employee through them in a way that is meaningful and relates to their own personal situation, and that calls for trust in the exchange of data, it calls for personalization at the front end so that when the when the employee accesses these services, they're able very quickly to get to the right solution from them because otherwise, you know that they're faced with looking at 30 different potential solutions and not really knowing what's necessarily right for them at that time.

And Hemal, I'd be interested in your views as well because you need Caroline's mentioned data there and obviously you can't have more access to digital health apps and support without generating more data. So, consumer privacy employee privacy becomes even more paramount. As far as an organisation is concerned, to instil that trust in employees to use the apps and the technology that's at their fingertips, or be it as Caroline said, you know, in a very measured way that is personalised to the individual's experience. But what opportunities does having access to anonymize health data, bring to employers and how can they then use that to benefit the workforce themselves in turn?

This is a critical issue in fact in this in this sort of trusted relationship between an employer and employees health data has always been extremely sensitive wherever you look at it around the world, people always feed back that they're quite late health data is different to other forms of data and people have a higher. I guess threshold for trusting people with their health data, and that's usually supported by legal and regulatory frameworks and safeguards in place wherever you are in the world, and data privacy laws are fairly stringent. And so the key thing for employers here is to be on the front foot. This is going to be an issue that will be in your organisation and in the minds of employees from the outset, and tackling it up front is very important. And to do that, head on and proactively reassure employees that their personal information will remain confidential and anonymous, and to show and demonstrate the safeguards that an organisation has put in place to make sure that that happens. And to be quite open and transparent, that you know, any data, even in an anonymous and confidential form, you know won't lead to any detrimental effect on people's career aspirations or their performance or any other aspect which tends to be a worry within organisations and even, you know, demonstrating some of the questions that we've asked in the survey that we're talking about today. And so I think I think all of those are really critical in making sure that employers address, but as you said, on the flip side, there's been very positive feedback, you know, 80% in the survey that we've conducted of employees are happy for employees to use anonymous data to improve their health and wellness benefits. And that's four out of five people and that surprised me. In terms of that type of response. But I think if the employees can have trust that the employer is going to treat the data and safeguard the privacy around that data, I think the survey demonstrates quite clearly that using that information to gain knowledge about the employees to gain knowledge about the support tools that will be most beneficial for them, I think is really key, and it goes back to a response that I made earlier on in this interview, which is, you know, understanding the population and understanding the needs that people have across the organisation will be quite individual to that organisation and then the interventions can be designed around that and I think using that and this permission to be able to use that type of data to help design the right interventions. There's a lot of things out there as Caroline said, and it's not about actually a dearth of tools and support services that are out there, it's about how you design them to impact positively your workforce and I think that's where organisations that have skills and expertise in that like your health benefits providers should be able to inform that discussion and actually provide some of those tools for you. So that organisations can remain productive and achieve their objective.

(42:05) Caroline I wanted to again come back to you because from a customer proposition perspective from looking at the needs of the individuals, we have absolutely an all survey covered off mental well-being mental illness, as in quite a broad context, but in the context of COVID, and the subsequent months, people who really began to see the extent to which people are suffering from mental ill health and I know we've touched on this a few times in terms of your financial well-being and how that impacts and your role and responsibility in the family, etc. But also, you know that there have been rising instances of domestic abuse, domestic violence, and people turning to substances whether that have that be alcohol to manage the situation that they find themselves in or other substances, so, as an organisation, how can we really help employees to navigate through this time, and ensure that they are returning to work, whether they've had, you know, a week’s absence or, a month absence, or returning to the office environment after being in lockdown for several months in a physically and mentally healthy way and supporting them through some of the experiences that they're current currently having.

It's a great question, that's a very thoughtful question, I think there are several approaches that employers can take I think the first one is always, you know, listen, listen to what your employees are saying, if they're not saying things, then that doesn't mean that there isn't a problem either so then you're down to the next part of the process which is around signposting. So there are lots of as we've said, you know, all the way through this, lots of support services available that will help people in very specific situations. So for example, a little known benefit under our EAP our employee assistance programme is the support and access to childcare. Now, that may not have been relevant or indeed practical right at the height of lockdowns but actually as we emerge from that and people want to ready themselves to get back to work, they may be struggling to get some of that support for their, their families, so it's about making sure that the signposting is clear. It's about engaging employees with all of the services that are available, but then it's also about being able to I think take a bit of a step back and allow your employees to access those services confidentially because you know people don't necessarily want their employer to know, very intimate and private things about their own life. So I think, making sure that you, as an employer, are working with a benefits provider that has that range of services from smoking cessation to help with alcohol issues, drug addiction, gambling, domestic abuse all of those kind of, you know, real crisis and trauma situations, making sure that there is that support available. If I reflect on our own response you know we really stepped up the engagement in vHealth during this time — I'm sure Hemal will go on to talk a little bit more about that — by opening up a service to employers. During the kind of very height of the pandemic. But also we've we launched a support service called Wysa, which is a mental health tool that can be used, you know, in times of difficulty but actually also in times of clear waters ahead, where people actually just want to check in on their mental well-being. So not every solution needs to be one that is there for a crisis, I think it's really important that we also give people the tools to manage their own mental health resilience during better times. You know, it will be some difficult times ahead, but eventually hopefully we'll come out with this bad dream, and there will be some, some level of normality returning. And so it's really important that people start to use those types of tools and gain support from them in the good times and the bad.

Hemal, Could I ask you for your opinion as well because as Caroline just in a very succinctly stated there, it's really important to consider your mental well-being before it becomes an issue before you reach crisis node. So, again, you know, from a from a signposting perspective, what do you feel are some of the most useful pathways that organisations can present to employees to really help them to develop healthier habits around their mental well-being?

Mental well-being is a really big issue. Now, particularly with COVID and the impact of lockdowns around the world, all the data and evidence is suggesting that between one in five to one in three people are suffering from clinical depression or clinical anxiety. And obviously, this doesn't happen overnight, and certain people deteriorate with their mental illness like they do with any other illness over time. And hence, having those support tools at different phases of people's journey is very important, and being able to present them in a way that they're able to access themselves, is quite important, and in the in the way in which they can access it. So whether that's through digital means like the service that we've got in place with Wysa, that people can access on their phones, very confidential advice and a chat based service, or to be able to speak to a clinician directly through the vHealth service.

(47:59) So, I'm really interested to hear your take on this as well. Hemal in terms of how best to sign toast individuals so that they're not only in crisis mode able to have a service or a solution that they can turn to, but the so that they can also develop healthier habits to keep themselves mentally well and as Caroline said check in with themselves on a, on a daily basis. What are your thoughts on how we can best support employees through this time?

Yeah, I think this is a really important question. I think mental illness and maintaining your mental health is really critical particularly during this group COVID crisis. We're already seeing through the research that is coming out that between one and three and one in five people are suffering from anxiety and depression, and that's replicated across the world, so we know the burden of illness is quite high. But this isn't something that happens overnight. And so it's really important that people have the support through their journey, through their mental well-being journey, all the phases, and generally when, when you're very ill, towards the latter end of that journey, that is the time where actually you become the hardest to reach. And so it's really important that employers, employees, colleagues and others are able to remain vigilant around deteriorating mental well-being. And employers can do a fair degree and I guess, select the right types of interventions to help support employees at the different phases of their journey so for example like Caroline described earlier we have, we have a service called Wysa for our own employees and also for our customers that provides a chat-based service for people who might need some support and be able to talk to someone around their concerns, and that usually can help, particularly in the early phases as people are finding it more difficult to cope. But we also have on the other end, a virtual health service that has medical professionals who are able to provide support in a in a different way to have Wysa can provide and be able to diagnose mental illness be able to refer into the right services should that be required, and also be able to prescribe interventions, as in when they're needed, and we have other services in between where we have talking therapies through employee assistance programmes. So, so the variety of those helps to support people at different phases in their journey, and all of them may not be required and people are able to choose which ones can help them, and were able to suggest as an employer around which ones that they can access. So I think that type of variety can really help to address this, increasing problem around mental well-being for organisations.

(50:46) So, Hemal your, your comments just now, obviously, we are coming from this from an international perspective, as I would say, 98% of the population have been able to continue working from home during this time, but obviously for a lot of our customers a lot of organisations around the world, those who have had to call workers home and have had to follow their employees. So, in, in terms of returning to work from their perspective, in terms of connecting with those people and making sure that they are still mentally and physically fit and well how best can organisations cope with that return to work phenomenon?

I think this is again another important area that shouldn't be forgotten and I think people will have, if they've been asked to stay at home for, whether it's through furlough schemes or whether it's for any other reason, and maybe they're more vulnerable than others, or they may have been made redundant and are now returning to work, all of those things will have an impact on people's mental and physical well-being and I think, making sure that that is taken care of, like we would do in any other return to work programme, I think is quite is quite key, and like with other return to work programmes, making sure that mental health aspects are covered within that I think also key. So, guiding people back and recognising that this is you know, a very unusual circumstance that we may have impacted people in different ways, using that opportunity to try and pick up on any anxieties or stresses that people have about returning to work, I think is quite key in making sure that the right tailored programmes are in place to support people as they, as they resume duties. And I think employers should think about that and again have conversations with their health benefits providers, because otherwise what will happen is the impact of getting people back into work quickly and without addressing some of these challenges will only result in an issue later on down the line, we know that presenteeism is already a problem, particularly with mental health illness and this will continue, especially as activity was used in many industries. And the last thing that you require as an employer is having a workforce that you haven't quite addressed the challenges.

Caroline, is this something that you would like to pick up on as well?

I think Hemal’s done a really nice job and covering all bases really, I think the only other thing to add would be, you know, we have to understand that although our frame of reference might be as primarily office workers, there are lots and lots of people who've never been able to work from home and have not been furloughed during this time, and their challenges will be different, and the solutions that their organisations can put in place will necessarily be different is very, very different, telling people that they can go out for a run whenever they want if they work in an office job, ordinarily, versus say factories or offshore workers were that their normal routines are just so different to that so you know organisations will need to get the support to be able to put in place programmes that will support those types of employees as well, because otherwise as Hemal says you know that the second wave may well be a mental health one.

(54:25) Absolutely and, and actually, the final piece that I wanted to touch on in terms of the digital health dilemmas and as we look at trying to improve mental and physical health and well-being, solutions for employees, from a consumers perspective, if we continue to develop our digital habits at pace, if we're embracing these innovative online-to-offline delivery models, we're becoming more empowered, decision-makers about our own health and well-being. What is Aetna International planning, in terms of its own digital transformation to keep up with demand for virtual access to health care, and well-being support? What does the future hold for the business and for its members?

So, you know, we've talked about this a lot throughout this interview. And I think this is really about being able to harness the solutions that are there and adding some new ones where we know that there are gaps and actually creating a coherent pathway for members through whatever journey it is they're on, whether it's one that is more kind of mental health lead, whether it is a physical health condition that they're dealing with, is putting together the set of potential helping tools and triaging the patient, the member through those periods so that we can make sure we can offer them something more personalised that they're then more likely to engage with, because we know we see an uptick in utilisation where we're able to personalise an offering more than the kind of generic signposting and almost advertising of the availability of a solution. So I think this is where the kind of combination of vHealth as a virtual primary care service, and some of the other third-party support services that we've engaged with so whether it's a virtual physiotherapy whether it is sleep help, whether it's around mental resilience and well-being, the likes of the Wysa solution that we have, or whether it's face to face or virtual counselling we offer that through our employee assistance programme. I think the key is bringing those services together in a way that is meaningful and coherent for the patient or for the member, so that's really what the future for us looks like — using the data that we have access to using the data that employers give us around the makeup of their employee populations and using all of that information and insight to be able to build programmes that genuinely meet the member where they are.

And Hemal, in terms of meeting people where they are, as the business's clinical authority. How do you see under international evolving and growing to meet the demands of consumers and members today and in the future?

Well, I think Aetna International is not immune to the circumstances around us and so we've had to put in all the things that Caroline just talked about to support our own employees across the world. And as a consequence, we've got a fair amount of learning that now we have in place. Some things we've done well and some things we could have done better. So when we're talking to our partners and our customers, whether they’re at an organisational revenue all within HR teams or whether on the frontline users who have access to, to benefits through us, I think, we now speak from experience, and we can guide organisations in a way that is hopefully more meaningful for them because we've been through this ourselves, and we're going through this ourselves and we're learning the challenges of how to support people during this this journey that we've talked about and what are the right tools and rights tools that we need in place to be able to do that. How do we understand our workforce better, how do we get the sense of where the issues lie across a multinational workforce. And I think as we start to understand that, and we've done a lot of work in this area we're very fortunate to work in an organisation that really cares passionately about its people. And so, we're able to transmit that knowledge and experience to our customers, but also give access to some of the tools that Caroline's described, you know, we've got access to tools that provide online physio for back pain, in addition to some of the things that we've talked about, you know, and these are real problems for organisations at the moment. Our vHealth service can coordinate healthcare across all services for people. And we've got those access to those chat environments to those employee assistance programmes, all of that together can provide the right level of support and I'm certainly hopeful about the future and the long-term benefits that that all of these changes will lead us to, obviously it's going to be difficult and challenging times but I think there's enough out there to help both us and international and also our customers to get through this really difficult period.

(59:40) There is without a doubt it is an incredibly difficult period but if I were to say to you how much, but you know I believe, and we believe that organisations today have a once-in-a-generation opportunity to really harness all the learning and to listen to what employees have to say and to make their environments, a stronger, healthier place to be, ultimately for the benefit of not only the employees themselves but for the longevity and sustainability of that organisation. What, what would you say about that opportunity to any employers who are listening?

I think it's an unrivalled opportunity and I don't know what bigger impact we could feel as society, as organisations, as individuals, than what we are going through now so I think the opportunity is there to create change to embed health and well-being, which is now at that critical point. I don't think as a global community we've ever talked about health and well-being as much as we are now, because this is a health crisis. And so, so I think the opportunity is there for everyone to embrace and embed how we want to live and work in the future and so I think I really encourage organisations to take that opportunity to improve people's health and well-being.

Absolutely and Caroline, What would you want, what would your answer be to the same question?

So, unsurprisingly, I would agree. I think it is a real moment of truth I think the organisations that will come out well, are the ones that are seen to do the right things by their customers and their employees. I think we also have to acknowledge that you know there's lots and lots of research around the importance of purpose-led organisations, particularly for the next generation of employees it's terrifically important to them to know that the organisation that they're going to join and contribute to is one that wants to do good in the world. And so I think, you know, harnessing the moment and thinking about the future workforce and thinking in terms of what's going to be important to them in terms of supporting their mental and physical well-being, so that their organisations remain productive profitable and can continue to grow in the future. All of those things are going to be really important as we come out with this crisis.

Fantastic, well I've really enjoyed today's discussion. Thank you so much, both of you for your time and for such genuine, authentic well thought through responses. And I think it's as you say it's really an exciting time for organisations to be able to revisit, to build lots of learning in and to harness the opportunity that is in front of them. So again, thank you so much, and I look forward to speaking to you again soon

We hope you enjoyed our comprehensive discussion on what employers can do to leverage the positive influences of digital tech on worker health and diminish the negatives. Our next podcast, looking at a clinical condition that is so commonplace it can seem to hide in plain sight. Cardiovascular disease is the world's number one killer. And I'll be talking to Dr Sneh Khemka, VP of population health solutions and vHealth at Aetna, about heart disease from prevention through to condition management, and the role of employers in employees’ health journeys. For those who don't know, Aetna International is a global health and wellness benefits provider, but we're more than just an insurance safety net, our skill lies in delivering the tools and the services and resources that really help to drive healthcare costs down and people's physical and mental health and well-being up. And that's something that's important to our corporate clients and self-funded members alike. That's why we currently serve almost 900,000 members around the world from Shanghai, to Seattle. Ultimately, we believe that when people drive their work and personal endeavours strive to. For more information about us, you can visit aetnainternational.com.