Behind the Research of the Surgeon General's Workplace Well-Being Framework: Q&A with Project Lead, Ashleigh Reeves
Over the past year, Empower Work collaborated with the Office of the Surgeon General (OSG) as they explored a critical question: “How can workplaces be an engine for well-being?” Our team had the pleasure of working with Dr. Vivek Murthy’s research team, including Ashleigh Reeves, Project Lead, OSG Innovation and Design Team, as they explored new recommendations for workplaces rooted in worker voice. And our founder, Jaime-Alexis Fowler, was honored to be part of the launch for the new framework this fall.
In December 2022, Jaime-Alexis sat down with Ashleigh for a digital “fireside chat” with the Empower Work community to dig into the research behind the framework. This is a transcript of their Q&A as they took a look behind the scenes at how the pieces came together.
Fowler: I want to start at the beginning, because I think for many of us, we don’t always get to see the background on what inspired or started a project like this. Can you share a bit about how this work started? What was the first question you were looking to answer?
Reeves: Jaime-Alexis, first of all, thank you for inviting me here today! I’m really excited to share my experience designing the Surgeon General’s Framework for Workplace Mental Health + Well-Being with you all.
And - also - hello to everyone on the call! As Jaime-Alexis shared, I’m Ashleigh Reeves. In my day job, I’m a senior organizational design lead at IDEO, which is a global design and innovation firm. But in 2022 I had the extraordinary opportunity to take a leave of absence from IDEO for an externship with the Innovation & Design Team at the Office of the Surgeon General, where I served as a project lead on the workplace well-being work.
For a while now I’ve been interested in the intersection of org design and well-being and how we might design workplaces and ways of working in a way that actually supports rather than detracts from the physical and mental health of the workforce.
I came to be interested in this connection both through my own experiences navigating fairly toxic workplaces and recognizing the toll that took on my health, but also because in the work I do as an organizational designer, I speak to so many workers across industries - senior leaders, managers, and frontline workers - across a diverse set of workplace contexts. And often what I find is that many of them are struggling. And while the individual challenges are unique, there are so many common themes. And these are themes that you see in the Surgeon General’s Framework.
And so, when I was approached with this opportunity to do this work, I immediately jumped on it because I truly do believe that we can use the power of design to reshape workplace environments and create the conditions where workers can thrive. And that positive impact will then extend beyond the workplace and individual workers - to their families and communities - and ultimately create a healthier society.
It might sound ambitious, but with the leadership and influence of someone like Dr. Murthy who cares so much about the well-being of folks in this country, I totally believe it’s possible.
And so, to answer your question about how this work started… Last Fall - before Omicron hit - it looked like we were finally coming out of the pandemic, and so Dr. Murthy and his team at the time began a listening tour of sorts to hear from folks, learn about their experiences, and begin to imagine how society might rebuild in a post-pandemic world. And I think what they heard (which is also borne out in research and data from that time) was that people were struggling with their mental health. But his team also recognized that there was a real opportunity to address these challenges and shift our culture for the better. So out of that came several of the initiatives that the Office of the Surgeon General has led this year - including addressing youth mental health, health worker burnout, and workplace mental health + well-being.
When I came onboard at the very end of 2021 to lead this project, Dr. Murthy had already articulated his vision and the central question that really guided our work. And that was: How might U.S. workplaces become engines of mental and emotional well-being to improve the lives of all segments of the workforce? With a footnote here that we really wanted to have a special focus on segments of the workforce that face a higher degree of job risk or instability as well as historically marginalized or underrepresented populations.
Fowler: That last piece resonated so much when we first connected because the intentionality and thoughtfulness around that really came out in our first conversations…I remember when I was starting Empower Work and talking to people about how jobs are really core to so many peoples’ well-being. When I was talking about the idea of a crisis text line, people thought it was a legal text line or something like that. Those services actually exist and are super helpful, but this is really about the core of how we support someone’s well-being because it’s so central.
As you started working on this framework, what were areas that surprised you about well-being at work?
Reeves: I think the thing that actually surprised me the most was when I realized that no comprehensive and accessible framework for workplace mental health already existed - at least not outside of academic research.
And I really should make that caveat because as part of our team’s research we spoke with a lot of really smart academic researchers who have dedicated their careers to studying workplaces and peoples’ relationships to their work - these are folks like Laura Kubzansky and her colleagues at the Harvard + MIT Workplace Well-Being Initiative, Jeffrey Pfeffer at Stanford, and Christina Maslach who is renowned for her research on workplace burnout. And while these folks have developed theories and models and contributed so much to the study of organizational science, their work might not feel readily accessible for business leaders and managers - who are the folks who are actually making decisions everyday in their workplaces that impact the well-being of their workforce.
And maybe another thing that surprised me - even though I noted earlier that anecdotally in my work as an organizational designer I often see and hear the struggles of workers - is the scope of the issue. These stats might not be all that surprising to this audience but I’ll share just a few that really illuminated the sad state of our workplaces:
According to a 2021 study from Mind Share Partners, 76% of full-time U.S. workers experienced at least one symptom of a mental health condition in the past year, up from 59% in 2019. The most common symptoms were burnout, depression, and anxiety.
In that same Mental Health at Work Report, 84% of respondents reported at least one workplace factor had negatively impacted their mental health in the past year—the most common being emotionally draining work and challenges with work-life balance.
Additionally, according to the APA’s 2022 Work and Well-Being survey, 81% of workers reported that they will be looking for workplaces that support mental health in the future. And what’s more, half of respondents have left previous roles at a company due, at least in part, to mental health reasons. (And that number grows to 81% of Gen Z and 68% of Millennial respondents.)
On the bright side…
Workplaces are taking notice and employees are seeing greater investment from employers - with 54% of workers reporting that they believe mental health is prioritized in their company, up from 41% in 2019. In addition, 47% of workers believe that their company leaders are advocates for mental health at work and that their managers are equipped to support them.
And while this growth in day-to-day support is promising, at the same time, the investment in culture is still unfortunately mixed overall. We find that the go-to response from many organizations is to offer wellness programs or additional benefits rather than examining the root causes of chronic stress and interrogating workplace practices that contribute to mental health challenges.
Fowler: I think that’s such an important point… Some of the people we support work in very small workplaces where they can’t offer the well-being pieces, but it’s also overwhelming to tackle some of the cultural or internal structures that drive some of those. For example, we support people that are like, “I’m a manufacturing worker in North Carolina and I’m frustrated by my lack of pay, but the thing that’s really impacting how I feel about the situation is that the toilet near the manufacturing floor has been broken for over a year.” It’s a daily indignity of disrespect that adds up and takes a toll on people.
Sometimes those small things add up, but when you’re that manufacturing plant owner that’s dealing with all of those different things in a pandemic, maybe that doesn’t come top of mind for you…It’s hard for particularly small employers which is one of the reasons I’m excited about what you said in your response about creating a framework that’s accessible to lots of different employees and business owners, no matter what their resourcing or size is.
Part of what has inspired me is the way in which you and the team were so thoughtful in both being open to partners and also at one point I remember one of the team (maybe it was you!) saying “Dr Murthy is a Surgeon General for all Americans…as the nation’s doctor he represents everyone and we want to engage with workers across the country” - that struck me as both so powerful and also a challenge.
How did your team balance the needs of so many varied constituencies as part of this work? Or How did you balance all partners and inputs?
Reeves: It was a challenge! But it was also really important to Dr. Murthy and to our team that whatever came out of our work would be broadly applicable to all U.S. workers across industries and contexts. As the framework was taking shape we were constantly checking ourselves to ensure that the essentials we were identifying and our corresponding recommendations weren’t biased toward any type of worker or workplace.
One way we did that was by not only talking to academic researchers and industry experts, but also talking to a diverse set of workers and leaders to hear their stories and learn about their experiences in their workplaces.
Doing that is actually really core to a human-centered design process. We can have what we think is the best idea or solution or product, but if it doesn’t resonate with the people it’s designed to help and if it doesn’t actually meet their needs then we’ve failed as designers.
So thanks to partners like Empower Work who opened up their networks to us, we had the opportunity to speak with workers and leaders from organizations of all sizes - from small businesses that employ 10-20 workers to senior leaders in billion-dollar companies.
My teammate, Corinne Vizzacchero, who is a design researcher at OSG led this phase of our research and although she wasn’t able to make today’s call she provided me with a summary of her research and I’ll share a few highlights…
We spoke with workers and leaders from a variety of industries including: healthcare, hospitality, finance, education, agriculture, construction, retail, technology, government, manufacturing, and professional services.
We spoke with frontline workers and supervisors, mid-level managers, directors, business owners, chief executives, heads of HR, and union organizers.
Our goal was to understand their experiences and needs in order to refine the Framework itself as well as to test the usability of our accompanying tools (like the reflection questions for leaders and teams) and the digital experience that the office’s really talented visual and interaction designers created.
And while we obviously heard many different perspectives in these conversations, our job was to synthesize all that we learned and identify themes and insights that helped to build our confidence in the framework and what we were putting out into the world.
Fowler: That human-centered approach comes across so clearly in the framework but also in the experience of going through it, and it resonates deeply with me because when I first started Empower Work, I did all these user interviews, trying to understand exactly what the pain point was and how people would use it.
One of the areas that meant so much to those in our community was being able to share their experiences directly. When we were first connected, I remember we thought we’d reach out to a small subset of users who’ve used the line and maybe try to reach out to 50 people or so and see what the response wass. We didn’t know so many people would respond! I think it felt so meaningful for people to be asked to contribute, what their feedback was, what their pain points were, and to feel heard around this. One worker who said yes to an interview said she felt so heard.
We see that in the framework: that workers and their voices are at the center. How did you keep that focus throughout the work? What stood out to you about the worker perspectives?
Reeves: Hearing you say that that worker felt heard is amazing. To me, that means we did our job!
When we first kicked off this project we sat down as a team - along with Dr. Murthy - to articulate our goals for the work. We had three primary objectives:
The first was to normalize this idea that workforce mental health and emotional well-being is a responsibility for businesses and to increase accountability for employers. This is about shifting from a belief that workplace stress is inevitable and the best we can do is mitigate its impact to instead proactively creating conditions that will support positive emotional well-being for the U.S. workforce.
Next, we wanted workplaces to evolve in their understanding of this issue and take meaningful actions that will significantly improve the mental and emotional well-being of their workforce. So we wanted to shift away from a trend of businesses investing solely in wellness programs that put the burden on the employee and instead take a more systematic approach that involves evolving organizational cultures and the nature of the work itself.
And finally - maybe our most important goal, given Dr. Murthy’s role as the nation’s doctor - we wanted the U.S. workforce to be seen and for their needs to be heard in this conversation. And we wanted key segments of the workforce - particularly those who are most vulnerable - to see evidence of these cultural shifts and reap the benefits of employers who prioritize their emotional health and well-being. Moving away from simply “getting by” and surviving the workday to flourishing at work and beyond.
So, while it was obviously extremely important that we built a sound framework with a strong evidence base, we knew it wouldn’t have an impact if it didn’t actually reflect the real needs of workers. And that’s why we grounded each of the five Essentials in universal human needs.
It doesn’t matter if I’m a grocery store clerk in rural North Carolina or if I’m a financial advisor in New York, I still have these basic human needs for security, belonging, autonomy, dignity… all of these things that I need my workplace to be supportive of in order to thrive.
And so, I think what stood out most to me about the worker perspective were those universal needs. Even before we would share the framework with workers in our interviews, we would first ask them to tell us about their workplaces and the moments when they felt they were at their best - you know, feeling good and doing good work. And without fail, we could map those stories back to one or more of our five Essentials and the needs they represent.
And honestly, I think that’s why the framework is so powerful. In some ways it’s so simple and straightforward, but because it’s rooted in these common needs it really strikes a chord with people and maybe that’s why it feels accessible and actionable in a way that other more-academic models might not.
Fowler: What has felt most meaningful about the launch? What are you seeing in terms of reactions?
Reeves: Honestly, it’s been gratifying, and amazing, and a little surreal to see the Framework - that we poured so much care and effort into - out in the world.
When we first launched the Framework in October it was awesome to see the media coverage… first, with the article in the Wall Street Journal, and then seeing it quickly get picked up by other respected publications. But maybe what’s been even more awesome - at least in my perspective - is to see the traction that it’s gotten on social media. It went viral on LinkedIn and has been shared by so many workers and leaders and really started a conversation about the importance of mental health at work. Which, again, was one of our primary goals for this work.
I’ve seen it pop up in different places… Someone sent me a Tik Tok about it the other day! I also saw it described recently as marking a “sea change in the way mental health at work is discussed” and that gives me a lot of pride but also a lot of hope for the future of our workplaces. I really hope that maybe this Framework really will make a difference in the lives of a lot of people. Hopefully we’ll start to see that impact soon.
Fowler: It’s been meaningful to us…we wanted to contribute to a framework that was accessible for smaller employers and teams. So we used parts of the framework for our internal touch-base with our team. As a smaller team ourselves, we want to make sure we’re living our mission of creating equitable workplaces internally and also learning from this so we can share out with other teams.
So the framework has launched now and the team is putting energy behind using it to move the needle. What are you most looking forward to as it gains traction?
Reeves: Well, now that I’m back at IDEO I’ve been spending a lot of time sharing the Framework with my colleagues who have also been sharing it with their clients. We have the privilege here of working with senior leaders in a lot of influential organizations, and the response we’ve received from these leaders is really positive. They’re looking for ways to improve the employee experience in their organizations and they recognize the importance of shifting their cultures in ways that support and honor the humanity of their workers. To that end, I’m building out additional tools and designing facilitated workshops to help these leaders learn more about their employees’ needs and to activate the Framework in their workplaces.
Similarly to what you’re doing at Empower Work, I’m really excited to prototype one of those workshops in our IDEO Cambridge studio with this community of designers. I think through that experience we’re going to learn a lot that our own Experience Team can use as they design programming for next year, and we’ll learn a lot about the tools we’re using which will inform the next iteration that we’ll hopefully be taking to clients very soon so we can really start to see that impact out in the world.