The Evolve Workplace Wellbeing Podcast
The Evolve Workplace Wellbeing Podcast
Energising the support provided to workplaces by local Government: WHISPAs research
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In this episode Prof. Kevin Daniels of the University of East Anglia speaks with Dr Laura Kudrna, Associate Professor in Health Research Methods and Professor Richard Lilford, Professor of Public Health, Co-Director of NIHR Midlands PSRC, both of the University of Birmingham. They talk about their current research on the topic of WHISPAs: Workplace Health and Wellbeing Initiatives that are Free at the Point of Use to Workplaces. They also detail the evidence and studies that informed the design of their forthcoming work trialling new packages of support and testing if they reduce sickness absence in participating employer organisations.
Find out more about WHISPAs here: www.whispas.co.uk
00:00:04 Helen Fitzhugh
Welcome to the Evolve Workplace Wellbeing podcast.
00:00:07 Helen Fitzhugh
This podcast is part of a toolkit of free evidence-informed workplace wellbeing resources provided by the Workplace Wellbeing Research Team at the University of East Anglia in the UK.
00:00:18 Helen Fitzhugh
You can find the resources on www.evolveworkplacewellbeing.org.
00:00:29 Kevin Daniels
Hello and welcome to the Evolve podcast.
00:00:32 Kevin Daniels
Today I've got Laura Kudrna from the University of Birmingham and Richard Lilford also from the University of Birmingham who are going to be talking about the WHISPAs project.
00:00:42 Kevin Daniels
And I'm not going to spell out what WHISPAs is yet because we're going to keep the listeners in suspense for a while.
00:00:47 Kevin Daniels
So I'll let you do that.
00:00:49 Kevin Daniels
So as ever, Laura and Richard, if you wouldn't mind kicking off by introducing yourselves and telling us about the project, what WHISPAs stands for and who else you're working with and what you hope to achieve.
00:01:01 Laura Kudrna
Thanks, Kevin.
00:01:02 Laura Kudrna
Really appreciate you having us on today.
00:01:04 Laura Kudrna
I work as an Associate Professor at the University of Birmingham in Applied Health Research.
00:01:09 Laura Kudrna
And WHISPAs stands for Workplace Health and Wellbeing Initiatives that are free at the point of use to workplaces.
00:01:16 Laura Kudrna
There are a lot of different offerings to workplaces, and many of them are quite expensive and they have quite high costs.
00:01:22 Laura Kudrna
This project focuses on looking at what's already provided to workplaces for free, primarily by different local government teams working across the UK.
00:01:31 Laura Kudrna
Our project is about better understanding and also energizing the support that's provided to workplaces by local government.
00:01:38 Laura Kudrna
Pass over to you, Richard.
00:01:39 Laura Kudrna
Thank you, Laura.
00:01:40 Richard Lilford
I'm Richard Lilford.
00:01:41 Richard Lilford
I'm a Professor of Public Health here at the University of Birmingham.
00:01:44 Richard Lilford
Prior to that, I've worked for five years as a civil servant, and before that, I was a Professor of Gynaecology, and I'm very proud to be associated with the WHISPAs project.
00:01:53 Richard Lilford
Great.
00:01:54 Kevin Daniels
Thank you, both.
00:01:54 Kevin Daniels
It is great to have you both on as well.
00:01:56 Kevin Daniels
I think this is
00:01:58 Kevin Daniels
certainly the first time I've had two guests on.
00:02:00 Kevin Daniels
I'm not sure whether it's the first time the podcast has, but it is great.
00:02:05 Kevin Daniels
So you mentioned what WHISPAs are.
00:02:07 Kevin Daniels
Give us a wider overview of the kind of things, give us a few examples, if you like, of what's happening, who's providing them.
00:02:15 Laura Kudrna
Our team has done a review of WHISPAs that are running across the UK.
00:02:19 Laura Kudrna
And we found over 60 different local government regions, plus some of the devolved nations, including Wales and Scotland, who are delivering these programmes.
00:02:28 Laura Kudrna
They all look very similar.
00:02:29 Laura Kudrna
They start off with a workplace health needs assessment.
00:02:32 Laura Kudrna
So asking employees what areas of health they might be struggling with.
00:02:35 Laura Kudrna
If you think about mental health or musculoskeletal health, for example, as predictors of sickness absence, are employees struggling with these?
00:02:42 Laura Kudrna
Are they willing to change what they're doing in these areas?
00:02:45 Laura Kudrna
And then there are a number of different modules that employers can go through in order to provide support to their staff.
00:02:51 Laura Kudrna
So for example, they might provide support on menopause awareness, musculoskeletal health, workplace bullying and harassment.
00:02:59 Laura Kudrna
There are training programmes for line managers on culture and how to change workplace policies in areas such as caring responsibilities or flexible working.
00:03:10 Laura Kudrna
So it's a holistic, multi-level, multi-component programme.
00:03:13 Laura Kudrna
A key feature of these programmes is that they tend to be funded by public health teams.
00:03:19 Laura Kudrna
There's actually a line in public health spending for local government on workplace award programmes.
00:03:25 Laura Kudrna
And everyone who participates has to upload evidence to show that they're
00:03:29 Laura Kudrna
actually progressing through these different modules.
00:03:31 Laura Kudrna
It's not an honesty box.
00:03:32 Laura Kudrna
It's not enough to say, oh yeah, we've got a new policy on sickness absence or caring responsibilities.
00:03:38 Laura Kudrna
You actually have to show that.
00:03:40 Laura Kudrna
And then government teams look at whether that's been uploaded and accredited and provide awards for going through different levels.
00:03:47 Richard Lilford
In terms of an evaluation team, we're not coming in from the outside and implanting something foreign in
00:03:55 Richard Lilford
local authorities or industry, we are going with the grain that's already there, which gives it, as I'll be describing later, more chance of sustainability.
00:04:07 Kevin Daniels
Yes, I think that's an important point that you make actually about a lot of intervention research is someone parachuting from outside, hangs around for six months and then goes away and doesn't look at the long term
00:04:19 Kevin Daniels
effects or doesn't allow things to embed in perhaps the ways that it should do as well.
00:04:25 Kevin Daniels
Actually, just got a little question on the nature of WHISPAs.
00:04:28 Kevin Daniels
Do you find that they're locally tailored?
00:04:30 Kevin Daniels
I mean, clearly Scotland has a lot of devolved powers, Wales has some devolved powers and a different legislative framework in Scotland.
00:04:37 Kevin Daniels
But even if you, know, so like is Sussex different from the West Midlands, it reflects something about Sussex or the West Midlands.
00:04:45 Laura Kudrna
Yes, I think so, because the areas of health need will be different.
00:04:48 Laura Kudrna
So for example, in some areas they have stronger alcohol and substance misuse programmes.
00:04:52 Laura Kudrna
So there might be signposting from the workplace public health team over into the substance misuse team in a way that doesn't happen in some other regions.
00:05:01 Laura Kudrna
But what's interesting is how similar they are in terms of their structure, the needs assessment, the different modules, and then also the awards at the end.
00:05:10 Laura Kudrna
And that comes because there used to be national workplace standards,
00:05:15 Laura Kudrna
about a decade ago.
00:05:16 Laura Kudrna
And these are no longer available to the public.
00:05:18 Laura Kudrna
But local government used to follow these standards and create these award programs on the basis of what was available.
00:05:25 Laura Kudrna
So that's why we're trying to recreate these standards and provide local government with the evidence that they need.
00:05:31 Laura Kudrna
They do, to answer your question, tend to be quite similar with a bit of local tailoring.
00:05:36 Kevin Daniels
Kind of interesting from an evaluation point of view, isn't it, but also from a sustainability point of view.
00:05:41 Kevin Daniels
So what's the existing evidence around
00:05:44 Kevin Daniels
Just kind of workplace health and well-being support delivered through local government.
00:05:49 Laura Kudrna
There have been a number of studies, especially around the 2015s or thereabout, that showed using non-causal kind of before and after designs
00:06:00 Laura Kudrna
that WHISPAs delivered through local government do have some positive impacts on things like sickness absence.
00:06:06 Laura Kudrna
There's a study conducted in the northeast and North Cumbria looking at whether self-selection and volunteering to participate in a local government WHISPA led to reductions in sickness absence.
00:06:18 Laura Kudrna
And the results were positive.
00:06:20 Laura Kudrna
They found, yep, workplaces who enrolled and progressed through these WHISPAs
00:06:24 Laura Kudrna
had employees take off fewer days sick.
00:06:27 Laura Kudrna
But of course, that's not causal.
00:06:29 Laura Kudrna
We can't necessarily attribute the effects on sickness absence to the programme itself.
00:06:34 Laura Kudrna
And so there was a trial run by Richard and colleagues actually, I met Richard in 2018, and funded by the Department for Work and Pensions
00:06:42 Laura Kudrna
looking at just that question, do WHISPAs causally impact health and wellbeing outcomes?
00:06:47 Laura Kudrna
Perhaps Richard can say a bit about that.
00:06:51 Richard Lilford
Yes, so as Laura’s just described in the previous study, organizations that volunteered themselves for the programme, experienced these improved outcomes, but we don't really know which way around the causal arrow is going.
00:07:03 Richard Lilford
Is it the kind of centre that puts themselves forward, which is completely plausible, or is it the intervention itself?
00:07:10 Richard Lilford
So just distinguish those two different hypotheses, if you like.
00:07:14 Richard Lilford
We were lucky to be approached by the Department of Work and Pensions
00:07:19 Richard Lilford
Back in when was it, Laura?
00:07:20 Richard Lilford
2018.
00:07:22 Richard Lilford
2018.
00:07:23 Richard Lilford
And so we did two things really.
00:07:25 Richard Lilford
We enhanced their offer.
00:07:29 Richard Lilford
Their basic offer was two levels of incentive for organizations, SMEs, small and medium-sized enterprises, to increase their attention they paid to workforce wellbeing.
00:07:40 Richard Lilford
We also added some additional components to that, working partly with our business school and the Judge Institute.
00:07:47 Richard Lilford
And then we did an evaluation of this enhanced, incentivized programme funded by the Department of Work and Pensions.
00:07:56 Richard Lilford
They funded the intervention and the evaluation.
00:07:58 Richard Lilford
And in the evaluation, we worked, by the way, with the mayor's office, the Andy Street's office in the West Midlands.
00:08:06 Richard Lilford
And we randomized 100 SMEs.
00:08:09 Richard Lilford
into four different conditions, a control, lower level of intervention, higher level of intervention, and followed them up over a period of time.
00:08:18 Richard Lilford
And we demonstrated that the intervention was causally associated with an increased offer, which was dose dependent on the incentive.
00:08:27 Richard Lilford
It was higher if the incentive was higher.
00:08:30 Richard Lilford
And we also found that the workforce appreciated that this offer had been made, so it registered with them.
00:08:39 Richard Lilford
When it came down to an actual change in their behaviours, for example, did they actually go to more exercise classes or doing mental health, hygiene or whatever?
00:08:49 Richard Lilford
Eat healthier.
00:08:50 Richard Lilford
Eat healthier.
00:08:51 Richard Lilford
There was no measurable change in behaviour.
00:08:55 Richard Lilford
Nevertheless, there were changes in these upstream predictors of behaviour.
00:08:59 Richard Lilford
And so that's been published.
00:09:00 Richard Lilford
And it was quite an effort to recruit and randomize 100 SMEs.
00:09:05 Richard Lilford
But it was a model.
00:09:06 Richard Lilford
It wasn't the first model.
00:09:07 Richard Lilford
There was a previous model in California.
00:09:10 Richard Lilford
Nevertheless, it was a model for how these interventions can be evaluated.
00:09:15 Kevin Daniels
And you mentioned 2018, because something happened in 2019.
00:09:20 Kevin Daniels
Did the trial overlap with Covid?
00:09:22 Laura Kudrna
We were so lucky to finish the trial before the pandemic hit and we were writing up the results with the team involved during the pandemic and then published them after the pandemic.
00:09:32 Laura Kudrna
So thank goodness, unlike many research teams, we weren’t
00:09:35 Laura Kudrna
scuppered by COVID.
00:09:37 Kevin Daniels
Have there been any economic evaluations of the benefits, whether it's the earlier trials you were talking about, Laura, or the big trial that Richard was talking about?
00:09:48 Laura Kudrna
They did find in the effects on sickness absence cost savings, that it was cost effective.
00:09:54 Laura Kudrna
I can't remember the exact figure, but it was per employee that they looked at the cost of the programme to say, yes, it is something that's cost effective.
00:10:02 Laura Kudrna
But it's something more that we need to know.
00:10:04 Laura Kudrna
And it's why our new programme of research has health economists who will be looking at the costs and benefits of these programmes in order to make an informed judgment there, out of Exeter.
00:10:16 Kevin Daniels
Okay, that's great.
00:10:18 Kevin Daniels
And can you tell us what more we need to know?
00:10:20 Richard Lilford
So, there's quite a lot more we need to know.
00:10:24 Richard Lilford
Firstly, we need to evaluate more programmes.
00:10:28 Richard Lilford
Secondly, the evaluation needs to take account of not just the effectiveness in one place and time, but also the sustainability of evaluations.
00:10:39 Richard Lilford
It's a bit of a bugbear of mine is sustainability because it's hard to solve because the funding cycle is usually
00:10:46 Richard Lilford
too short.
00:10:47 Richard Lilford
And then of course the scalability.
00:10:48 Richard Lilford
So those are important factors to try and consider and build in going forward.
00:10:55 Richard Lilford
And then there's another issue with evaluations and that is the model which served us reasonably well in clinical trials and indeed in educational trials where you do your randomization and then hypothesis test at the end.
00:11:13 Richard Lilford
That's really inadequate for
00:11:15 Richard Lilford
this kind of study because the amount that the dial moves on valued endpoints like people's health, for example, is going to be very small when you've intervened a long way upstream, but will affect a large number of people.
00:11:31 Richard Lilford
And so even a small movement in the dial could be cost effective, but you'll miss it and you'll be stuck in this no man's land of failure to demonstrate significance
00:11:44 Richard Lilford
is not evidence of insignificance, and then what to do.
00:11:49 Richard Lilford
So, what I'm really trying to do is move away from this hypothesis testing approach to statistics to a much better alternative, which is a Bayesian approach.
00:12:00 Richard Lilford
There are two points to make here.
00:12:02 Richard Lilford
The one is that properly done, the Bayesian approach can make use of all the evidence that you collect, not just the valued endpoint.
00:12:10 Richard Lilford
And second of all, it doesn't dichotomize the valued endpoint into positive or null.
00:12:15 Richard Lilford
It gives you a probability of an effect of a given size.
00:12:19 Richard Lilford
That's much more useful for a model.
00:12:21 Richard Lilford
Any model needs that probability.
00:12:23 Richard Lilford
Any decision model, including a health economic model, requires that probability.
00:12:28 Richard Lilford
And by using this,
00:12:30 Richard Lilford
modern statistical method, that this can be achieved.
00:12:33 Richard Lilford
I say modern as a sort of mild joke because actually Bayesian statistics have preceded the hypothesis testing model.
00:12:41 Kevin Daniels
Yes, I'm A Bayesian modeller myself.
00:12:43 Kevin Daniels
Oh, there you are.
00:12:45 Kevin Daniels
But to sort of put that in a language a manager could understand, it's essentially rather than saying this does or doesn't work, what a Bayesian approach would say this, you've got a 75% chance of this working.
00:13:00 Richard Lilford
To X degree or whatever, yes.
00:13:03 Laura Kudrna
And I think that's so much more appealing for policy teams.
00:13:06 Laura Kudrna
And we've heard that it's so much more appealing for policy teams because politically, you don't want to say, this doesn't work or this does work.
00:13:13 Laura Kudrna
It's rarely binary that's helpful.
00:13:16 Laura Kudrna
Instead, you want to know how confident you are that it is going to work if you invest in it, given the other competing use of resources and trade-offs that you make.
00:13:25 Richard Lilford
You know, Peter Diggle, who is past president of our statistical society, said to me once that a
00:13:29 Richard Lilford
Statistical model is a way of testing a scientific model, and that's the approach we should take, rather than this light switch: it worked or it didn't.
00:13:40 Kevin Daniels
Yes.
00:13:40 Kevin Daniels
And to go back to your earlier point about the [unclear], we take an employer like the NHS, huge numbers of people, an intervention only has to work in 10% of the people for, you know, the workers for it to be actually quite a profound effect across the organization as well.
00:13:56 Richard Lilford
And when summed across many organizations, if it is scalable, then the effect is greater still.
00:14:02 Laura Kudrna
Yes, it's so hard to create a change in people's behaviour.
00:14:06 Laura Kudrna
I think intentions to change health behaviours explain such small variance
00:14:10 Laura Kudrna
in actual change.
00:14:11 Laura Kudrna
And if you can get that dial to move at all, to be able to scale it up to a larger population is something that is important to recognize.
00:14:21 Kevin Daniels
One thing you mentioned earlier though is that you're looking at these WHISPAs, they're already established.
00:14:27 Kevin Daniels
So this
00:14:27 Kevin Daniels
does pose challenges for evaluation because you don't have a baseline.
00:14:31 Kevin Daniels
You don't have what happened beforehand.
00:14:34 Kevin Daniels
So I'm quite interested in how you're going to evaluate them.
00:14:38 Kevin Daniels
So what is the approach you're taking?
00:14:42 Laura Kudrna
I'm curious to hear what Richard says because it's an ongoing conversation with the local government team.
00:14:46 Richard Lilford
So because I come from a clinical background, I'll give you an analogy.
00:14:50 Richard Lilford
It's like people who are on a small dose of preventive treatment
00:14:55 Richard Lilford
trying a larger dose.
00:14:57 Richard Lilford
So what we are doing, what we're doing will be augmenting the WHISPAs process in terms of the dose, doing more of the same things and the time, doing more different things.
00:15:08 Richard Lilford
So our evaluation is of that kind.
00:15:13 Richard Lilford
It's starting from what's already there.
00:15:15 Richard Lilford
Have we made a difference through that?
00:15:18 Richard Lilford
Now, part of your question is about baseline measures.
00:15:22 Richard Lilford
It would be very nice
00:15:23 Richard Lilford
If we could, we will have baseline measurements, won’t we?
00:15:26 Richard Lilford
So, we'll be able to do statistically [unclear], but it's like a difference in difference.
00:15:32 Richard Lilford
So we'll look and see whether there's a bigger improvement in the intervention sites than in the control sites.
00:15:38 Richard Lilford
And I say more sophisticatedly, we'll be controlling for baseline performance.
00:15:45 Laura Kudrna
And it's really common to have a usual care group.
00:15:47 Laura Kudrna
So, there'll be people in workplaces that have the usual care.
00:15:50 Laura Kudrna
They have the local government support.
00:15:53 Laura Kudrna
They might have another type of support.
00:15:55 Laura Kudrna
But the first two years of the project are all about adding evidence-based recommendations to what WHISPAs are currently doing.
00:16:01 Laura Kudrna
What do we know is best evidence for musculoskeletal health at work, for example, or mental health?
00:16:06 Laura Kudrna
Do we have an evidence-based programme for menopause awareness?
00:16:10 Laura Kudrna
And we'll make sure that those recommendations
00:16:12 Laura Kudrna
are augmented as a higher dose so that they can test the super version of the programme versus usual care versus everyday practice.
00:16:21 Laura Kudrna
But you're right, when something else is going on, it can potentially dilute the effect of the intervention, but it does make it more socially appealing as well because...
00:16:29 Richard Lilford
Well, it makes it more useful.
00:16:30 Richard Lilford
I mean, no one's going to take WHISPAs away.
00:16:33 Laura Kudrna
Right.
00:16:33 Richard Lilford
So we’ve got WHISPAs.
00:16:34 Richard Lilford
That's not the question anymore.
00:16:36 Richard Lilford
It's sort of should it be an enhanced package?
00:16:39 Laura Kudrna
Exactly.
00:16:40 Laura Kudrna
Should we have this enhanced offering or not?
00:16:42 Kevin Daniels
OK, great, great.
00:16:43 Kevin Daniels
Thanks for explaining that.
00:16:44 Kevin Daniels
And that's really quite useful to say, actually, we've got them.
00:16:48 Kevin Daniels
How do we make them better rather than saying, do they work or not?
00:16:53 Kevin Daniels
So yeah, I like that approach.
00:16:56 Kevin Daniels
So when you do this evaluation or trying to augment the existing offerings, what kind of problems are you facing and how are you going about solving them?
00:17:05 Laura Kudrna
In augmenting the evaluation in terms of some of the problems and the challenges, one of the things that's always a challenge in this type of approach is recruitment of small to medium-sized enterprises.
00:17:17 Laura Kudrna
They're extremely challenging to recruit and retain in research.
00:17:22 Laura Kudrna
And so one of the ways that we have designed this is so that much of the work sits with the local government teams who have the expertise of engaging with the small to medium-sized enterprises already.
00:17:33 Laura Kudrna
So we funded a fabulous embedded researcher at East Sussex Council down south.
00:17:38 Laura Kudrna
She just started last week, in fact, and their team is responsible for convening a UK-wide local government group to recruit the SMEs.
00:17:48 Laura Kudrna
And there are some problems in this area more generally.
00:17:51 Richard Lilford
Yes, I mean, there are some additional things to think about.
00:17:55 Richard Lilford
So one of the sources goes through my mind is the extent to which this work and health offer
00:18:02 Richard Lilford
is separate to what, how much do you separate it from good management?
00:18:09 Richard Lilford
I guess this will appeal to you as an organizational psychologist is that it strikes me as intuitively, but I mean, this is, I haven't put this to empirical test, that the more you can integrate things like health, the health offer in the normal activities of the firm and making them less like, oh, today we're going to do health,
00:18:33 Richard Lilford
the more likely it is to become, A, attractive to the organization and B, scalable in the long term.
00:18:41 Richard Lilford
So that's a, I don't know how we'll test that hypothesis, but maybe just take it as a given truth.
00:18:47 Richard Lilford
And related to that is the interesting question of productivity and health.
00:18:54 Richard Lilford
I think we know that a healthy workforce is more productive than a sick workforce, but that's not quite the same as if I go and implement
00:19:01 Richard Lilford
a health routine, how much of that over the relatively short time space that I have to work in as a manager, how much dividend, if any, will I get from that?
00:19:14 Richard Lilford
And there's no general, I don't suppose there's a general answer for that question.
00:19:17 Richard Lilford
It may be quite specific.
00:19:19 Richard Lilford
But I’m put in mind of that by an economist I met who got a grant to implement, you might call it a more humane, more person-centred, employee-centred HR policy in
00:19:32 Richard Lilford
in the garment factories in Dhaka, in Bangladesh.
00:19:36 Richard Lilford
And his main outcome was productivity.
00:19:39 Richard Lilford
And not just because he's an economist, but because he had reason to believe that if he could demonstrate an improvement in output, then that would really make it a compelling argument for people to implement.
00:19:56 Richard Lilford
But again, of course, I don't know what he found.
00:19:59 Richard Lilford
I should try and look it up.
00:20:00 Richard Lilford
But.
00:20:02 Richard Lilford
But one of our outcomes in this study is sickness absence, which of course is linked to productivity.
00:20:07 Richard Lilford
And so I think that's an intriguing and interesting topic.
00:20:10 Kevin Daniels
But I think this point about integrating health into sort of mainstream activities is a very, very important point.
00:20:20 Kevin Daniels
And we drew a lot of inspiration in our work across from high hazard industries, where they would talk about safety climate
00:20:31 Kevin Daniels
and safety culture and then the consequences of unsafe behaviour are often immediate.
00:20:37 Kevin Daniels
So which is why, high hazard organisations invest quite a lot in establishing
00:20:42 Kevin Daniels
strong safety cultures.
00:20:44 Kevin Daniels
But we've seen organisations that do the health stuff and not necessarily in high hazard industries as well, but do the health stuff really well.
00:20:50 Kevin Daniels
It's an embedded and cultural thing within the organisation.
00:20:54 Kevin Daniels
So it does become part of the mainstream business thinking, if you like.
00:20:58 Kevin Daniels
Getting there can be quite a lengthy process.
00:21:03 Kevin Daniels
And the point about SMEs, they're often time poor.
00:21:05 Kevin Daniels
So having those intermediaries
00:21:08 Kevin Daniels
There's actually a guy who works in your city.
00:21:10 Kevin Daniels
If you cross to the north side of the city and go to Aston University, Professor Monder Ram in the business school is a colleague of ours, does a lot of work with SMEs and he always talks about having trusted local intermediaries.
00:21:21 Kevin Daniels
So this embedded researcher you've got in Sussex.
00:21:24 Kevin Daniels
Knowing, some of the local government, they, they'll know the chambers of commerce and they'll know the small, the local federation small business rep, so they will have those connections which, when you're sat in an office in
00:21:39 Kevin Daniels
in any university, I was going to say in a large city, but even in a small city like Norwich, you're not out there knowing what the concerns are of the small businesses because you're not hearing that and you're not hearing it from people who work with those small businesses and are trusted by them.
00:21:53 Kevin Daniels
So I think that embedded approach should be, I’m really interested to see how that is evaluated, but the results around that as well and how that good practice can spread because I think you know you could be on to something really important there in how you get these to...
00:22:08 Richard Lilford
That was Laura’s genius to try this....
00:22:09 Laura Kudrna
It was also from seeing how important it is to fund the people who are doing this frontline work.
00:22:18 Laura Kudrna
And when I moved from London to Warwick for the first trial that we did in 2018,
00:22:25 Laura Kudrna
We were providing money to organizations and a free offering to enhance staff health and wellbeing.
00:22:31 Laura Kudrna
And I thought it would be easy to recruit businesses to this.
00:22:34 Laura Kudrna
I cold call.
00:22:35 Laura Kudrna
I said, we're giving away money and happiness.
00:22:37 Laura Kudrna
They had no interest.
00:22:39 Laura Kudrna
And I learned how important those relationships are that the local team had with the SMEs.
00:22:44 Laura Kudrna
And that's why recruitment and retention and sustainability with these companies is so important.
00:22:49 Laura Kudrna
And there are things that local government teams are doing that attracts that.
00:22:53 Laura Kudrna
So they'll have events
00:22:55 Laura Kudrna
for example, that aren't about health and wellbeing, that are about recruiting and retaining staff or productivity, workplaces come to that and then they start to have the conversation about health.
00:23:05 Laura Kudrna
Or there's another team, Essex, who has put these
00:23:08 Laura Kudrna
health checks in the community where people can check their height and weight and blood pressure, and then it refers them to the programme that they're doing on work and health.
00:23:17 Laura Kudrna
So it's almost this foot in the door behavioural technique that establishes the relationship that you can then go forth with.
00:23:24 Laura Kudrna
And I'd like to learn more about those practices and spread those through an embedded researcher.
00:23:29 Richard Lilford
People are very interested in that, in signals from their own body, you know, whether it's their blood pressure, their pulse rate, you know, they are interested in that, so that might be a hook.
00:23:38 Kevin Daniels
But also I think the incentives aren't just monetary for businesses.
00:23:43 Kevin Daniels
And local teams will know that, of course, which again is, at a distance
00:23:50 Kevin Daniels
You can't see that as easily or intuit that in a way.
00:23:55 Kevin Daniels
So again, I think this localist approach.
00:23:58 Kevin Daniels
And are you making plans to sort of evaluate across contexts?
00:24:03 Kevin Daniels
as well because you mentioned Essex, it's very, very different from the West Midlands, East Essex.
00:24:07 Laura Kudrna
Incredibly, yes.
00:24:09 Laura Kudrna
So we have really talented researchers that are based at Newcastle and Teesside who will be leading the qualitative component using a realist approach in order to understand why and how this works and in what context.
00:24:24 Laura Kudrna
They've actually developed already a theory of the way in which WHISPAs operate and they'll be using that in order to inform what's happening going forward.
00:24:33 Laura Kudrna
There'll also be implementation recommendations that are being developed by the University of Hertfordshire.
00:24:39 Laura Kudrna
I believe you've had Nigel Lloyd and his colleagues.
00:24:41 Kevin Daniels
Yes, we have.
00:24:42 Laura Kudrna
Yeah, so we're working with them and they are doing the implementation approach that's taken qualitative as well.
00:24:47 Laura Kudrna
So it's very much what are the different contexts as well?
00:24:51 Laura Kudrna
How does that inform the success of the innovation?
00:24:54 Laura Kudrna
What do we need to learn?
00:24:55 Laura Kudrna
What tailoring needs to be done and so forth.
00:24:58 Kevin Daniels
Question I want to ask you now.
00:25:00 Kevin Daniels
So you got the big Mayfield review and Get Britain Working
00:25:04 Kevin Daniels
There's also this stuff about NEETs: not in education, employment or training and the Milburn Review.
00:25:10 Kevin Daniels
How do you see, well both WHISPAs and actually the wider sort of research that's going on around the country because there are multiple projects being run as well, how would you see those fitting in with this bigger policy thing?
00:25:24 Laura Kudrna
So when we were writing the grant application, Keep Britain Working and Get Britain Working didn't exist.
00:25:32 Laura Kudrna
And by the time we were funded, they did.
00:25:35 Laura Kudrna
And I immediately ran to Richard and I said, Richard, what do we do?
00:25:38 Laura Kudrna
It looks like they might be developing the same thing.
00:25:41 Laura Kudrna
And Richard said, don't worry, I know exactly what to do.
00:25:44 Laura Kudrna
And we set up a call and we discussed how to approach it.
00:25:47 Laura Kudrna
In reality, if you are both developing something that's really similar, you can still test it and still have the programme.
00:25:53 Laura Kudrna
When you get down into the details, it's rarely exactly the same.
00:25:57 Laura Kudrna
As Richard has said earlier on in this call, you might have different doses, for example, of the same intervention.
00:26:03 Laura Kudrna
But actually, we're not doing the same thing at all.
00:26:06 Laura Kudrna
So with Get Britain Working, it's about people who are out of the labour force coming back into work, and we're not really looking at that.
00:26:11 Laura Kudrna
We're looking at people who are already in work.
00:26:13 Laura Kudrna
And then for Keep Britain Working, it's very much employer-focused interventions for people who are already in work, and we do align there.
00:26:21 Laura Kudrna
Keep Britain Working has a healthy working life cycle.
00:26:23 Laura Kudrna
We've chatted with them about this.
00:26:25 Laura Kudrna
It has recruitment and onboarding, healthy in work, sick at work, and then what happens when they start to fall out of the labour force.
00:26:31 Laura Kudrna
And we're very much focused on the middle of that healthy working life cycle.
00:26:35 Laura Kudrna
For our evidence review, we'll be tagging the evidence such that it can inform what Keep Britain Working are doing as well in order to ensure that it aligns.
00:26:42 Laura Kudrna
So I think it's really important that these government priorities are happening when it's an area of need.
00:26:48 Laura Kudrna
Many people are working in the same place.
00:26:50 Laura Kudrna
I think let 1000 followers bloom is the idea and we can all contribute something.
00:26:56 Laura Kudrna
We're very keen not to duplicate effort and to add.
00:26:59 Laura Kudrna
And I think the local government and SME focus is something that's additional.
00:27:04 Richard Lilford
Laura has a sort of quite a nice seat in the arena because she's working in the Cabinet Office three days a week.
00:27:11 Richard Lilford
And indeed, I was a member of the Cabinet Office Evidence and Trials Working Group until a few months ago.
00:27:17 Richard Lilford
So between us, we've got quite a good overview.
00:27:21 Richard Lilford
Our mission really is to try and get evaluations off the ground as early as possible.
00:27:27 Richard Lilford
And that coincides.
00:27:29 Richard Lilford
Well, that's what the Cabinet Office Group is all about.
00:27:32 Richard Lilford
From my experience of it, though, the quality of the evaluations is often compromised by the fact that they come quite late to the Cabinet Office, where at a point when they are about to move into the field in two months or something or three months.
00:27:50 Richard Lilford
And that constrains the possible designs that you can
00:27:55 Richard Lilford
that you can implement before it starts to go live.
00:27:58 Richard Lilford
And it also means you can't get your, you're speaking yourself, Kevin, about getting baseline measures.
00:28:03 Richard Lilford
It reduces the chance of getting baseline measures in the intervention group because they've already started.
00:28:07 Richard Lilford
So of course it's still better than nothing, but there is some work to do and you could use your influence in government now, Laura.
00:28:16 Laura Kudrna
As a civil servant, I'm not influencing, I'm serving.
00:28:19 Richard Lilford
Well, within the, within the, within the, within that's technically correct.
00:28:23 Richard Lilford
But within the, within the civil service, you can try and get, you know, some of these ideas pumped out to the evaluation teams earlier on so they can be given a, you know, better evaluation.
00:28:35 Richard Lilford
So sort of trying to get earlier into government is the next step, I think.
00:28:38 Laura Kudrna
And the evaluation task force that I'm seconded into, that's exactly what they do and through the
00:28:44 Laura Kudrna
work that they've done over the last several years, they've increased the proportion of business cases that have evaluation plans attached to them.
00:28:51 Laura Kudrna
Work is going in that direction.
00:28:52 Richard Lilford
Oh, that's very encouraging.
00:28:53 Kevin Daniels
So, okay, so thank you both very much.
00:28:56 Kevin Daniels
One last question, if I may.
00:28:58 Kevin Daniels
What next?
00:28:58 Laura Kudrna
We've got to deliver our five-year programme of work.
00:29:01 Laura Kudrna
We are all set up, just finished hiring, and we're looking forward to hopefully making a splash to really support and energize the work of local government in this area.
00:29:10 Laura Kudrna
We've got two years of looking at the evidence to add to what they're doing
00:29:14 Laura Kudrna
and really put the best evidence in the hands of these local government teams and about three years to run the trial and evaluate it.
00:29:20 Laura Kudrna
And then, as Richard has said, I really look forward at what else we can do around understanding things like productivity.
00:29:26 Richard Lilford
And to make this a model for evaluation by using this causal chain approach.
00:29:32 Laura Kudrna
And finally, get away from this idea that if it's a null result, it's a problem or it shows that we shouldn't continue with the intervention because null results can teach us a lot, especially if there's been a process evaluation, especially about what outcomes change.
00:29:45 Laura Kudrna
And I'd like to see us get away from this idea of don't fund something just because it's null.
00:29:50 Laura Kudrna
Make sure that you're learning from that and thinking about how to improve the intervention going forward.
00:29:55 Laura Kudrna
Because of course,
00:29:56 Laura Kudrna
We need support for work and health.
00:29:57 Laura Kudrna
It's just what this looks like.
00:29:59 Kevin Daniels
There are a couple of evaluations out there which we've reviewed in reviews.
00:30:05 Kevin Daniels
There's not very many, I suspect, given the number of protocols that you see published and the number of trials results that you see published.
00:30:13 Kevin Daniels
I think this happens quite a lot, more often than you think, that basically the intervention never takes place.
00:30:21 Kevin Daniels
It never gets to fruition.
00:30:24 Kevin Daniels
Now, these two studies
00:30:26 Kevin Daniels
I’m talking about, one was actually from England.
00:30:29 Kevin Daniels
There's possibly a second one in there, but that intervention did get through to some.
00:30:34 Kevin Daniels
And one was in Australia, which is basically...
00:30:37 Kevin Daniels
the employer organisations just pulled out of the intervention.
00:30:40 Kevin Daniels
And you can learn so much from the people who are brave enough to write up, that actually it didn't work.
00:30:47 Laura Kudrna
Yeah, and that's one of the great things about being academics.
00:30:49 Laura Kudrna
We can say that.
00:30:51 Laura Kudrna
We don't have to be tied to our funders.
00:30:53 Laura Kudrna
We have that independence, and that's crucial.
00:30:55 Richard Lilford
But I'm fascinated by this.
00:30:58 Richard Lilford
You've given me an idea for a study with perhaps you as a partner?
00:31:01 Richard Lilford
A study where we track protocols in difficult areas.
00:31:06 Richard Lilford
and see what happens to them.
00:31:07 Kevin Daniels
I don't think anyone's done it.
00:31:10 Kevin Daniels
I was going to say, but it's a fascinating idea.
00:31:12 Kevin Daniels
If not us then somebody.
00:31:15 Kevin Daniels
So I think that would be a terrific thing to do to actually follow through.
00:31:19 Richard Lilford
They always say on papers, et al, I'm an [unclear] et al.
00:31:24 Laura Kudrna
Maybe we could get a medical student on that if that was something.
00:31:27 Laura Kudrna
Because we're going to have a meeting about projects for medical students soon.
00:31:31 Laura Kudrna
So perhaps we can propose.
00:31:32 Richard Lilford
Well, if you’d care to partner with us as a collaborator, we'd be very happy to do that.
00:31:36 Kevin Daniels
Ok we could talk about that off air...
00:31:38 Richard Lilford
Now that the interview is over, your conflict of interest is resolved.
00:31:44 Kevin Daniels
Excellent.
00:31:45 Kevin Daniels
Well, thank you both very much.
00:31:47 Kevin Daniels
It's been absolutely fantastic.
00:31:49 Kevin Daniels
I really enjoyed listening and learning about it.
00:31:51 Richard Lilford
Yeah, we enjoyed talking to you.
00:31:54 Laura Kudrna
It was a real great opportunity and obviously I've learned a lot from the work that you've done, so much appreciated.
00:31:59 Kevin Daniels
Thank you.
00:32:00 Kevin Daniels
Thank you.
00:32:00 Kevin Daniels
So yeah, and we'll be looking out for your results when they come about.
00:32:05 Kevin Daniels
So that's great.
00:32:06 Kevin Daniels
Fabulous.
00:32:06 Kevin Daniels
Thank you.
00:32:07 Richard Lilford
Bye now.
00:32:11 Helen Fitzhugh
Please do visit www.evolveworkplacewellbeing.org
00:32:16 Helen Fitzhugh
We look forward to seeing you next time.
