Addressing Holistic Health at Work with Ashish Kothari and Barbara Jeffery

Ashish Kothari: Hi, Barbara. It is so lovely to have you on our podcast, my dear friend.

Barbara Jeffrey: Ashish, I'm delighted to be here. Always lovely to talk to you.

Ashish Kothari: You know, for our listeners, a little backstory, Barbara and I met in the midst of one of the most contentious client studies we could have ever had. To some extent, we were almost pitted as adversaries, not really, but with two completely different points of view.

In that context, we had two different clients with competing perspectives on what the right answer was. It's important to remember the word perspectives because there are no rights and wrongs definitively in life. Most things are in the gray zone.

I just absolutely fell in love with Barbara in terms of how she was able to be the peacemaker and counsel the client. None of that would have been possible without her mastery of personal resilience, how she navigates adversity, and difficult situations. We're going to dive a lot into that today.

But first and foremost, Barbara, I am just blown away by what you have built over the last four years with the McKinsey Health Institute. I love the tagline: Adding years to life and life to years. Who doesn't want that?

So share with our listeners some of the amazing work you're spearheading in the domain of holistic well-being.

Barbara Jeffrey: Thank you, Ashish. That's too kind. Even in adverse circumstances, I always loved working with you. That says a lot about your personal qualities as well. I am delighted and very privileged to work as part of McKinsey Health Institute on top of my client work as well.

MHI was founded with an unbelievable mission, which is, over the next decade, how do we add 45 billion years of extra higher quality life? It's not just adding years to life, it's adding life to years. I feel incredibly privileged to work on that. Specifically, a topic close to my heart that I've had the opportunity to work on is employee health and well-being.

That's a core part of our healthy living and one of our core planks of MHI. We work across historically underfunded and resourced areas of healthcare, from brain health to healthy aging to infectious disease, through to sustainability and health. Employee health and well-being plays such an important role in helping everyone live happier, healthier lives.

Ashish Kothari: I love that. MHI historically works in underfunded areas on the healthcare spectrum. Employee health is the right place to be, because even though funding has increased over the last several years, I believe that 99 percent of it is wasted.

Real funding that makes a positive impact on the health of employees is very little. So, I'm glad you're shining a light on the role of organizations in employee health, as that's where we spend most of our waking hours.

Barbara Jeffrey: Fully agree. She could not agree more. And I agree with you. We know nine out of 10 companies are doing something, particularly post-COVID. It really shone the spotlight on employee health well-being. I just think they're investing in the wrong things.

That's one of the things that underpin the research, which is actually what drives real health outcomes and real work outcomes. Therefore, this isn't about investing more. It's about investing better.

Ashish Kothari: Exactly. So we'll get into a lot of it. We are so much on the same page on this one in terms of the role of the different areas you could invest. That's what I get excited about. That's the reason I decided to dedicate my life. I'll be 50, by the way, on March 9th.

Congratulations. And I'm speaking at this Gross Global Happiness. I'm in a gift that the universe gave me on my birthday. They're like, here you go. Go spend time on this. Go spend time on flourishing.

So, let's start with a definition because most people don't fully understand. They think they do, but they don't. So let's define holistic health and why it is so important in the workplace.

Barbara Jeffrey: So we had lots of debates around this and we decided to go with the four dimensions of health: physical, mental, social, and spiritual.

Let me just take a moment to define each of those elements. Physical health, we define as the extent to which an individual can competently perform physical tasks without significant discomfort. Most people intuitively understand physical health.

Mental health we define as an individual's cognitive, behavioral, and emotional state of well-being. Social health is about an individual's ability to build healthy, nurturing, genuine, and supportive relationships.

And spiritual health, which was the area that, particularly at McKinsey, we debated a lot, A is what to include, but also the definition. It isn't about religion. It's about the extent to which people integrate meaning into their lives. We're seeing that much more with people, particularly the younger generation, really wanting to connect to their purpose.

Ashish Kothari: And I love that. Viktor Frankl in the fifties said, "Today we have more means to live and less meaning to live for." We are in an epidemic of hopelessness and meaninglessness, which are such killers around well-being.

Barbara Jeffrey: Fully agree. And I love his book. I'm a big fan. It's one that I return to every couple of years just to remind myself. He's wonderful.

Ashish Kothari: Yeah. And so even relevant today in our times. Think about those four elements. And if you're listening, friends, just do an assessment. Where are you in terms of social health? Physical health, physical comforts.

This is an area, especially as we get older, we struggle with a lot. Our bodies can put up with a lot. I myself am a living example of that. I'm blessed with this body that for 25 years, the amount of abuse I've put it through between late-night drinking, not enough sleep, and food, and it's still somehow carrying on.

My commitment in my 50s to really focus on my physical health is a big one. So you'll see a lot of that. But it's really important because we often neglect our physical health and use substances to numb our emotional stress and well-being by abusing, borrowing from physical health.

I love that you included social health in the research, Barbara. I recognize how important social relationships and connections are to flourishing. But very rarely have I seen social health as a separate domain. I loved that you included it because it's so important.

In our day-to-day work, we take away from relationships. We put everything into work and take away from friends, family, and community. Forget about broader relationships. So I love that you include that.

Barbara Jeffrey: One note on that, actually, for me, the eye-opener was on social health. We know that loneliness and social isolation is a killer.

Ashish Kothari: Yep.

Barbara Jeffrey: And I didn't realize this until I started doing this work. But loneliness and social isolation is as damaging to an individual's health as smoking 15 cigarettes a day. That blew my mind. And in a world where nearly 30 percent of elderly people report feeling lonely, that is shocking. And that for me was the killer stat that I remind myself of regularly.

Ashish Kothari: I love that. Repeat that for our listeners, Barbara, because it's a really important one. People do not understand how important this is.

Barbara Jeffrey: Yeah. So loneliness and social isolation can be as damaging to an individual's health as smoking up to 15 cigarettes per day.

Ashish Kothari: Think about that, friends. And so why it's so important to invest in this domain. So I get it for an individual. Talk a little bit, Barbara, about why this is so important in the workplace. Why are these four elements so important in the workplace?

Barbara Jeffrey: Yeah, so as we thought about employee health and well-being, it is about holistic health. When we look at the underlying drivers behind those things, many of those things feed into each other.

There are a lot of studies that show if you're moving and have physical health, that improves your mental health. Social health also improves your mental health. Being in good mental health improves your ability to connect socially.

Having some sense of meaning and purpose at work helps drive productivity and also helps your mental health. These are all interconnected. We saw a real opportunity and need to think about addressing holistic health.

We did a deep dive initially on mental health coming out of the pandemic because that was the crisis we saw and there was a lot of attention on that. But doing that work, we realized that many organizations wanted to have the broader conversation on supporting employees across holistic health because so much of this is hard to disaggregate.

Ashish Kothari: And you can't really disassociate mental health from physical health. Mind and body are fundamentally connected. I'm glad that evolved into this holistic well-being conversation.

So talk a little bit about the amazing research, including the important role that organizations play rather than individuals, and things that individuals can do in this. How are you seeing clients move from knowledge to actual practice? And if you can share a couple of examples of those, that would be amazing.

Barbara Jeffrey: As ever, Ashish, there are always a few front runners around this. We're increasingly seeing a movement towards understanding that this is an issue, not only that, but it's becoming a C-suite issue.

The things that have driven that have been coming out of the pandemic, but also investors starting to understand that there is a big correlation between a company's workforce and the degree to which they are thriving and actual performance.

There are studies that now show improved stock market performance. So there's not just a moral case for doing this, there's also a business case.

Actually, off the press, we haven't published this yet, we've got a paper coming out very soon. We've also sized the business case for this globally. We think if you get this right, it's worth between a 4 to 12 percent uplift on GDP, which is huge.

Ashish Kothari: Massive.

Barbara Jeffrey: So even if you can't necessarily capture all of that, capturing even 10 percent of that is a major driver for both economies and businesses. We do see some front runners.

There are also a lot of companies that are skeptical around this, and then you have a large proportion of organizations in the middle that understand it's important but are under huge financial pressures and other pressures in the world right now.

The extent to which they're going to do this is dependent a bit on it being forced upon them rather than proactively moving.

But my view is, you can either take the opportunity to do this yourself or you can wait and have this done to you because we're seeing increasing evidence from investors and the workforce making choices based on how they're investing in their employees. Ultimately, I don't think businesses can wait.

Ashish Kothari: I was having a conversation with a Fortune 500 CEO and the leadership team. I gave them the same imperative, Barbara. I asked them how many of them thought the earth was flat. Everybody looked at me as if I was saying something weird.

500 years ago, 50 percent of you would have said yes. It's just that science has proven, and now you all believe Earth is round. 50 years ago, half of you would have said global warming is not real. Today, 90 percent of you agree.

The point that you're making between the research you are just about to publish, Alex Edman's work that showed 2 to 3.5 percent incremental shareholder returns from employee satisfaction, Yano Manuel's work on Oxford around return on assets and work well-being. The science is here, dear friends.

The invitation is what Barbara is saying and what I've been saying all along, which is the only choice you have is, when you look back in 50 years, were you the front runner who truly made it a source of competitive advantage and created a 50 to 90 percent alpha for your shareholders through investing in human flourishing?

Or were you one of the ones who had to be dragged there? Because if you don't move first, this is not a source of competitive advantage. At the heart of competitive advantage is that you do it before others.

Barbara Jeffrey: 100 percent agree. We are absolutely convinced it's a source of sustainable competitive advantage. That doesn't hang around, as you say, Ashish. So, you can choose to bury your head in the sand or you can choose to live.

Ashish Kothari: Exactly. So let's talk about movement and what companies should think about doing. This research you did was amazing. Thank you for the investment you all made into it. 30 countries, 30,000 individuals interviewed. What were some of the biggest findings on this topic, Barbara, that really stick with you?

Barbara Jeffrey: The first was really around when we looked at this across the organization, it was perfectly possible to have good holistic health and also experience symptoms of burnout at the same time.

Globally, we found that 57% of employees report being in good holistic health across all four dimensions: social, spiritual, physical, and mental. But we also found that around one in five employees globally were experiencing symptoms of burnout, which we define as exhaustion, mental distance, emotional impairment, and cognitive impairment.

For me, I had not realized that those two things are independent of each other. So if you think about holistic health on one dimension and burnout on another dimension, there's a group of the world, which we call faring well, that's about 50%. The half glass empty view is the other 50% not in that top box, not reporting both good holistic health and few signs of burnout.

There's a group of about 10 percent who are in the stretching zone, well-functioning, reporting good holistic health, but showing high signs of burnout. That's a worrying group.

Another group, about 30%, is in the managing group, having low burnout symptoms but not reporting good holistic health.

Then there's the final quadrant, the drowning group, not reporting good holistic health and having high burnout symptoms.

A lot of the focus has been on the drowning group. But we're also really worried about that additional 40 percent of people in the managing and stretching group. That is an important group because they can very quickly tip into that drowning group.

Ashish Kothari: Yeah. So, Barbara, I'm curious. I'm looking at the white paper now again, and I had this question and forgot to email you, so I'm going to ask you now.

When you look at holistic health, I want to talk a little bit about what does it actually mean when we say higher functioning and what's the impact of that.

Are they performing even at the level that you want and they're just struggling, not coping well mentally and emotionally, or what exactly did you all mean when you said higher functioning?

Barbara Jeffrey: What we looked at is a scale that we use, which is a one to five scale for each of these different elements that we looked at. Ashish, I'm sure that you and I, at some point, would put ourselves in that group.

We actually, physically, I was running, I was walking, mentally, I felt like things were fine. But if you look at the burnout scale, including the short scale, when you look at the individual components of that, I would probably have marked a few of those off myself.

I never tipped into full burnout, but there were definitely moments in my life when I was probably in that stretching zone without really knowing it. There is a group that is in that zone, and until you're prompted to ask yourself the questions, you may not even realize you're in that zone.

Ashish Kothari: I love that, and it very personally touches me. It connects with me. This zone will be familiar to you if you're a consultant, a banker, or a senior executive. This is that zone when we have overextended ourselves for weeks or have gone days with minimal sleep, working on a deal.

We think through coffee and sheer grit that we are muscling our way through. We tough it out, that's what you do. But the reality is our performance is nowhere close to where we think we are. We are 30 to 40 percent less effective, thinking slower, not making the right decisions, emotionally less regulated.

So I love that you're capturing that we might be functioning, as in we're not dead or completely taking a break because we can't handle anything anymore, but it's that zone. And there are so many who find themselves in this zone right now because of the changing world.

Barbara Jeffrey: Yeah. Interestingly, we didn't actually translate self-reported perceptions of performance into how productive you actually are. That is an important point you make.

One of the core findings was the opportunity to shift the focus from optimizing poor health to better health. It's really about moving from the focus on people who actively need support, which employees should obviously do, to those in the middle zone.

Life works across a spectrum, and at some points, you're at one end and another point at the other. Even within mental health or physical health, you're not always going to be at your peak, and you're not always going to be in the middle. The ability to support people along the spectrum is really important.

Ashish Kothari: This is a really important point because of all the conversations I've had in the year and a half. So much resource goes towards supporting those who are not well, but proactive care and creating interventions for people who are towards being more healthy is crucial. They might not be sick, but we can all be healthier. It's an important message here.

Barbara Jeffrey: Absolutely. This is not about deprioritizing the AP systems or people in crisis, who you absolutely have to support, full stop. However, that's been the only focus or a disproportionate part of the focus.

When you look at the business case, most of it is actually moving people to optimal health, not so much moving people out of the crisis point. That's where the opportunity lies.

It's much more about proactive investments that avoid people getting into that zone so you can unlock productivity, attract employees, and have a happy, healthy, thriving workforce, rather than just focusing on people who need critical support. It's about how you support everybody.

Ashish Kothari: It's about the 80 percent, in your case, 87%. How do we, because even those who are faring well, as any athlete would tell you, just because you're doing well, doesn't mean you can't do better. We all have those growth edges.

Barbara Jeffrey: 100 percent agree. And again, this is self-reported, right?

Ashish Kothari: So amazing. So number one, you said burnout and wellbeing are two different things. You can be burnt out and functioning well. Second, don't just support people who are suffering. It's about moving everybody to better health. Beautiful. What else?

Barbara Jeffrey: The third one was really about the need to think about different layers of the organization. We developed this model looking at both what we called demands and enablers, but we also looked at the factors beneath that, and we looked at over 30 factors, and we looked at those as individual, job, team, and organization level levers.

We wanted to understand what was driving those health-related outcomes as well as those work-related outcomes. What we saw is that if you're looking at poorer outcomes like burnout, over 95 percent of the negative variance is driven by job and team level.

When you look at holistic health and the impact on holistic health, that picture totally changes. Individual, job, team, and organizational factors become much more important. Holistic health is driven by the enablers, while the burnout symptoms are driven much more by demands at the team and job level.

This is really important, Ashish, because if we go back to those conversations we had about investments, most employers have really focused on the individual and the reactive. The opportunity is at job, team, and organization level, and it's about developing a holistic framework that also looks at the enablers.

Some examples of stressors and enablers to bring that concept to life: stressors include workload, work pressure, toxic workplace behavior, interpersonal conflicts. Enablers include organizational level leadership commitment, career customization, psychological safety, job autonomy, and individual levers like adaptability and self-efficacy.

As an employer, you need to think about both reactive and proactive measures, and you can't just focus on the individual. You can't yoga your way out of this. This is really about building a comprehensive portfolio of interventions to drive holistic health.

Ashish Kothari: Absolutely. And this is the part of the research, friends. If you haven't had a chance to see it, we'll put a link in our show notes to this article.

I really urge you to think about this and go into it because this is at the heart of the work we're doing in Happiness Squad. This is at the heart of what we need to do. Individual interventions, more headspace, more calm apps, more things that we give to individuals is not going to cut it.

As Barbara said, even if you look at health, only 27% is individual. A lot of it in terms of the enablers are around things that as organizational leaders, you integrate into the job team and organization.

And on burnout, it's almost 97 percent of those what Barbara and team are calling demands, like this notion of feeling under pressure to get work done, not having enough time, things of those natures, the role isn't clear. So really highlighted.

And this also will highlight for you why it is so important that these are not training HR initiatives, because guess who's creating the environment day to day. It's the business leaders and the teams. It's not HR.

This is not about policies. This is not about training people more, but this is about really getting curious about the state of development around these and integrating them into your work.

Barbara Jeffrey: And just on that note, we often get asked where to start. So if you're thinking about addressing burnout, it is those demands that we were talking about. The top three are toxic workplace behavior, role ambiguity, and role conflict.

And when we looked at all of the different drivers, interestingly, work pressure came up higher than workload. So that's a great place to start. If you're thinking about moving people to more holistic health, then those individual drivers and those other drivers become much more important, and it is a more comprehensive basket.

So when we look at the top enablers that enable really good holistic health, all those four dimensions we were talking about, it's about self-efficacy, adaptability, belonging, meaningful work, and psychological safety.

So all of those things really help move people to much more optimal health. But interestingly for me, if you're thinking about becoming more effective, more adaptable, that's only really possible if you're in a good place.

You can't do that if you're in a really bad place. And that's why, if we think about how much individual drivers contribute to burnout, that's only 3 percent of the variance that explains because you can't affect it yourself if you’re there.

Ashish Kothari: You cannot.

You looked at 30 countries, Barbara, and one of the countries, and I actually extended my stay over the holidays in India, was India, right? A real outlier. So almost 59%, the number was so high around burnout symptoms, versus the global average, as well as other countries.

I think there were three countries above 30, and then there was India at 59 percent or something. I'm sure you had tons of debates and discussions around this. What do you think is causing such a big spike in India?

Barbara Jeffrey: That is a big question, Ashish. And one of the things that we are doing is country deep dives to understand that.

Look, our model probably explains about 50 percent of the variance. So we can talk about the things that employers are doing. However, there's also a bunch of other things that aren't in our model, including cultural factors and other things.

So, I'm going to hedge a little bit. We are still doing the more detailed work country by country. We're also doing the more detailed work industry by industry, actually to really understand the different patterns behind that. So, rather than give a definitive answer, I'm going to ask you to watch this space, if that's okay, Ashish.

Ashish Kothari: I will. And as just input, in dialogue, I talked with about 10 CEOs or CXOs in India this January around this topic. The first response was, “really?” And then, a head nod, look back, and something I didn't expect: "Makes sense. Wow. Makes sense."

And I asked, why does it make sense? These are the answers that I got back. So just as input into as you look at specifically the India model, because I think a billion five, 300 million middle class, booming economy growth, this is quite a relevant topic.

Barbara Jeffrey: I'm taking notes. I'm putting these in. This is going to go forward.

Ashish Kothari: So number one is a lot of day-to-day friction in life. Long commutes, two hours in the morning, two hours in the back. There's a lot of people who are asking people to come back to the office.

So that's just an overall friction in life that results in, you know, if you were in the stretching zone, the life actions are going to pull you into burnout because that's just an additional load you didn't think about.

The second is a disproportionate point of punching out. There are many people who are in stretching punch out to say, "Okay, I can't take this anymore."

When you're in a country with a billion five people, 300 million middle class, more graduates and PhDs without jobs, the punch out happens a lot later and probably not till you are burnt out or close enough to it because there are 10 others to take your job.

So there is a second element in terms of just the demand-supply mismatch between the growth in the country, the opportunities, and the number of mouths to feed.

The third one that came up was historically, India has been a relatively hierarchical workplace, where the boss is, quote-unquote, king, and people are afraid to use their voice to say, "Hey, this isn't working" or "No, it is not right."

Also, for the longest time, India was a six days a week work culture, not five days a week work culture. And even today, there are many at the senior levels or even beyond, if called to say, "Hey, we're going to get on a call on a Sunday," people will get on a call on Sunday.

So you saw spiritual wellbeing spikes in India because of meaning and connection, it's a very cohesive place. But this whole notion around the work and kind of external, those were at least the three to four things that came up that would explain why we are actually seeing higher degrees of burnout symptoms in the sample.

Barbara Jeffrey: Fascinating. We've actually got a collaboration with a foundation in India to look at this, looking at it across Indian companies. So we'd be fascinated to carry on the conversation as well, Ashish. We should just continue the conversation. And I'll let you know when our both our country and our industry research comes up as well.

Ashish Kothari:

Please. So I want to switch to, we talked, we covered a lot already around burnout versus well-being. We covered a bit around proactive approaches. You talked about many of the drivers, the demands and enablers that organizations really need to invest in.

They are organizational capabilities, not individual. There are things that we need to do really into how we run our programs and how we integrate well-being.

So Barbara, we've talked a lot in the space of well-being and burnout and action, this notion of well-being being different than burnout. Let's focus proactive. Let's focus on all the demands and enablers that are very organizational job team level. 30 drivers is a lot. You highlighted the top five or six, right, as well.

One of the things that always inspires clients is just to look at interventions that work, et cetera, and what others are doing. So talk to me a little bit about some of the things that you're finding in your research and the resources you all are making available through MHI for companies.

Barbara Jeffrey: Yeah. So as you know, we try and work evidence-based. There's a lot of stuff out there, and it can feel a bit like throwing spaghetti at a wall sometimes and seeing what sticks.

What we've tried to do is start to build an interventions database, which we've got as part of our employee health from the NIH platform. One core part of the mission is to make things open access. That's available; you just have to sign in and have a login.

Within that interventions database, we look at the academic literature around proven interventions that work. But we also have a number of case studies which are open access around what companies are doing. They're publicly sourced.

There are case studies from very large companies like Patagonia or Unilever, and some smaller companies as well. It's a great resource, and we're continuing to build it out for people to use. We want to make sure that this is open access and that we're building a set of data that people can add to.

We'd also love to hear from people if they know of things that they've tried and that have worked. We've got everything from the burden of evidence from a full-scale randomized clinical control trial right through to more simple case studies. It's work in progress, and we're building it, but we're excited about starting to build the evidence around what works.

Ashish Kothari: Friends, I have dug into this and it is super generous for McKinsey, the level of investment that's gone into it, MHI, Barbara's work. We had a chance to connect together about six months ago.

I contributed our elements of what we were doing. It's open access. So any providers, any solution providers, and any company leaders who are doing well-being work, please look at that website, please look at that database. You'll find lots into it and please contribute freely. This is a huge issue right now for every organization, for almost every country.

Only if we contribute collectively behind this effort to enrich through practice and lived experiences, things that are working versus not, will we make a difference here. I'll put the link in, but please look into that and leverage it for yourself and contribute back.

Barbara Jeffrey: Thank you, Ashish. That's very generous of you.

Ashish Kothari: So I want to end, Barbara, with a note. Many people think around well-being and, you know, you are a partner in McKinsey, you're a mom, you serve clients, you're also involved with MHI, there's a lot of additional pro bono work I know that you do as well.

So I would love for you to share with our listeners what might be three or four non-negotiables or ways in which you make sure that you are continuously filling your cup.

You are implementing some of the practices that you're researching that allow you to be able to do what you're doing because, for me, you're operating at such a high level and the amount of work and impact you're having is super admirable.

Barbara Jeffrey: Well, thank you, Ashish. I sometimes feel a little bit like a doctor in the sense that I'm very good at telling others what to do and then being less consistent about doing it myself.

I'm very happy to share. It's about making sure that you do things across all four dimensions. Everyone has their own practices and one for me is just about consistency. I'm a strong believer in doing something is better than nothing. Just do it, then do it again.

Some things that really help me are consistency and what I call doubling up. So being able to hit all of the dimensions simultaneously. For example, I love to walk and run because movement's really important for me. When I'm in the office, I can go for a run on the treadmill and it hits my physical part.

Even better, I enjoy it much more if I can walk or run by the river in nature because I live close by to a river. That's doubling up. Last weekend I could even triple up. I went for a walk with my friend and her dog, we took the kids and then you've got the social interaction as well.

So you've got the spiritual connection to nature, the physical exercise, and the social connection. My mental health was buzzing after that. Just simple things around consistency doesn't have to be big, just small. And the more that you can double, triple, or quadruple up, the better because we've all got busy lives and that makes a huge difference.

Another thing that I do is very simple practices. The one thing that makes such a huge difference to my mental health is the gratitude exercise. I think about what are the three good things that have happened to me today that I'm really grateful for.

And I also acknowledge one bad thing, because that's also important. But most importantly, I try and do that with my kids as well. So we talk about that at dinner if I'm home for dinner or breakfast the next morning if I'm not. It also builds that as a lifelong practice for them.

That's just something that we do as a family as well. And it really gets us to connect. We love to eat together as well, because that for me is a huge part of the spiritual and social part for me as well.

Ashish Kothari: Amazing, amazing practices. Barbara, thank you for making the time to come and have this conversation on the Happiness Quad podcast. So grateful for you, for our friendship and for all the amazing work you're doing, my dear friend.

Barbara Jeffrey: Ashish, it's been an absolute delight. Thank you so much for having me. And I can't think of a more important way to spend my time.