Inner Quality Management EMPOWERING TOTAL QUALITY PROGRAMS WHILE LOWERING HEALTH CARE COSTS by Dan Bishop, President, National Family and Business Association It's no secret that escalating health care costs are eating up more and more corporate profits. The largest contributor to these soaring expenses is unmanaged stress. One million employees per day are absent from work due to stress related disorders. 72% of American workers experience frequent stress-related physical or mental conditions, and workers compensation claims increased 700% in California during the 1980's due to stress related illnesses. Research shows that stressful responses to workplace events, such as downsizing, the recession and inter-personal conflicts, are the major factors behind illness, substance abuse, high turnover and low productivity. It's a crowded market for stress management programs, but nationwide they have had little impact on reducing stress. As a result, many employers have lost interest in them. Yet, awareness of the "stress problem" has never been greater. Those in the field recognize that "stress management" has hit a ceiling with little new being offered. To take the prevention, reduction, and treatment of workplace stress- related issues to a new level will require a shift in focus. A Northern California educational and research corporation called the Institute of HeartMath (TM) (IHM) has developed a more people-sensitive approach that is proving highly effective in all branches of the military, gang risk intervention projects, prisons and schools as well as businesses. Their research and training focuses on factors that affect mental and emotional balance and the ability to manage stress effectively. The HeartMath think tank has designed Inner Quality Management (TM) programs to facilitate the reduction of stress and empower the total quality process. Bruce Cryer, Director of Corporate Training for the Institute says, "The lack of personal self-management is greatly responsible for the devastating health care costs many companies are combating today. TQM (Total Quality Management) will remain a corporate underachiever until companies recognize that Inner Quality is the prerequisite. Most employees today are simply not equipped to deal with the mental and emotional fluctuations they go through which can have a profound impact on job performance as well as personal relationships. Results from training people in many industries show that inner quality-based programs enhance communication skills (an oft-cited source of employee stress) and cooperative action, increase personal flexibility, and enable individuals to act coolly in the face of crises and deadlines." Redefining Empowerment Most businesses employing TQM practices consider empowerment to be asking employees to take on more responsibility and more decision-making, often without an increase in salary or benefits. While some businesses must do this to survive and others do it trying to increase job satisfaction and productivity, many employees are not finding this to be empowering at all, but increasingly stressful. Many see "empowerment" as just a trendy concept to get more work out of them. To top it off, the increased pressure and responsibility is often accompanied by company downsizing and anxiety about job security. A major research study has confirmed that many attempts at empowerment actually are counter-productive. Saturn Corporation, one of the brightest spots in General Motors, places high value on their personal development program. Eleanor White, Training Leader for Saturn says, "The only way we can do business is to have people work together in a positive way. So, we have a Human Skills Development Training which is the foundation of what our company is all about. It creates a positive environment that we all want and need and the impact on the cars is unbelievable. It works because it focuses on human interaction." These quality principles seem to hold true for government as well. Andy Michael, lawyer and legislative aide for California State Assemblyman, John Vasconcellos, (who founded California's Self Esteem Task Force) sees IQM as the launching pad for total quality management and eventually could even overshadow the TQM process itself. Michael says, "It's critical that we acknowledge the individuals as being the source within the system or the power of the system, instead of the system imposing itself on the individual. In the wake of downsizing, there's an incredible amount of instability, insecurity and emotional trauma. I believe IQM will empower the new management styles." Stress in the Workplace A Northwestern National Life Insurance survey released this year reported that: 34% of U.S. workers said they considered quitting their jobs because of excess stress; 46% described their jobs as highly stressful (twice as many as in 1985); and 33% said they believe job stress will lead them to "burn out" soon. Worker's compensation claims are climbing dramatically as a result of job stress claims. A typical stress case is likely to be twice as costly as the average industrial injury claim--more than $15,000 each in medical treatment and lost work time. In his book "Self Empowerment: The Heart Approach to Stress Management", researcher and founder of IHM, Doc Lew Childre, points out, "It would startle most businesses to have a computer readout weekly, showing the amount of work-time their employees spent thinking and emoting over their problems. Then, if you had another computer readout showing the amount of negative hormones released into the body as a result of those thinking habits, and the health consequences, in the name of smart business you would want to make some mental and emotional adjustments. Computers can't generate all that data yet, so we don't have to face the facts. Yet, the facts of stress will find us--anyhow. The stress deficit accrues, whether or not we are conscious of it." As stress becomes managed, quality increases (see diagram below.) In many workplaces employees are expected to "manage their own stress" and be committed to the company without employers being equally committed to providing a work environment which is safe, healthy and caring. As a result, employees often don't trust employers and don't see any reason to be loyal. A professional in Chicago told me, "I keep trying to plug into this place, but my boss keeps moving the outlets." Unless an effective solution for reducing health care costs is found, some experts believe companies may resort to imposing strategies basing health care coverage on whether employee lifestyle choices correspond to the current medical opinions of what constitutes healthy behavior. Commenting on a new company wellness program, a factory worker in Maryland indicated, "I don't want management coming in here and telling me how to run my life. I wouldn't trust these guys as far as I could throw them. What do they want from me now?" Whether the company is in manufacturing, electronics, or service delivery, certain patterns are common. As stress sets in and isn't released, it wears and tears on the entire system, undermining company programs and goals. It affects the family, schools, business, government--the whole social system. Businesses can no longer consider it a luxury to deal with stress and must start giving their people effective tools for managing and preventing it. Whether the motivation is soaring health care costs or poor performance in TQM programs, businesses must address stress as a tangible liability on their balance sheets. Cryer states, "With employees spending more of their life at work than in any other activity, employers have a responsibility to 'grow people,' if they want to grow their business. What do you think is going to motivate people to follow a quality program? The high energy motivational approach does help encourage employees to a certain degree, but you have to get down to what factors block enthusiasm and effectiveness personally and company wide, and then provide a more supportive, open environment. Most stress management programs focus solely on lifestyle approaches like diet and exercise. Some companies are now incorporating benefits such as flex-time, day-care centers and family leave, all of which are good but people still need practical tools to deal with daily challenges. The genuine care employees receive directly affects their quality of work and the customers know whether care is a catchy ad slogan or a sincere company attitude." Cryer adds, "Many companies cannot afford to increase benefits but they can create a more supportive environment that encourages employee participation and personally rewards and acknowledges accomplishments." Trends in Total Quality and Empowerment Increasingly, trend analysts are pointing to a paradigm shift occurring in business and recognizing that education and training must be made available to organizations to empower their managers and employees to meet the challenges and rapid changes. Charles C. Manz, recipient of the Marvin Bower Fellowship at the Harvard Business School, stated in his article for The Journal for Quality and Participation, "Just as the human body needs a strong heart nourished by a healthy diet and exercise, work systems based on empowerment can benefit greatly by devoting emphasis to strengthening the self-leadership skills of employees -- the heart of empowerment." Stephen Covey, in an article for the same journal, writes, "The inside-out approach means that organizational quality is achieved through developing personal quality. Organizations are groups of people working together, using shared resources to achieve related purposes. The basis of organizational quality, productivity, and high performance is people, not assets or things. People control and govern all other dimensions of the organization." In an article for Management Decision, Robert E. Ripley wrote, "The practice of empowering subordinates (associates), as well as one's self, is now one of the principal components of managerial and organizational effectiveness. Innovative organizations will include the highest quality education and training systems." Cryer concludes, "Lasting quality will come from incorporating inner quality concepts into the company priorities. When you have teams of people working together with inner quality-driven management you start to see people self-initiating, supporting co-workers, walking and talking the total quality concept. It's really a matter of creating a joint venture between the head and heart to gain individual, team and corporate empowerment, enabling individuals and teams to become aware of their internal energy leaks and plug them so they can move on. Only when people learn to manage their inner business, can they achieve another level of efficiency and empowerment, significantly increase productivity, and finally get a grip on stress so that health care costs return to an acceptable level." Dan Bishop is senior Managing Partner of Business Communications, based in San Jose, and former Senior Vice President of Packard Bell Electronics, Inc. He can be reached at (408)-338-0915. Copyright 1993 Dan Bishop. All rights reserved.