The X-Factor in wellbeing and
People who feel well perform better than people who feel ill. This arises because individuals who
feel well can look outside of themselves and focus on their work, whilst those who feel unwell
tend to focus more on the sensations within themselves of feeling unwell - a form of protection.
The individual perception of wellness is idiosyncratic. People with a diagnosable illness may feel
well, whilst someone with no recognisable illness may feel unwell. The idea of wellbeing and
wellness embraces sensations of anxiety, depression and fear, which, at their lowest intensity,
may not register as being externally identifiable. It’s not uncommon for people feeling depressed
to appear to be well and difficult to diagnose. Nevertheless people with low intensity unwellness
tend to focus their attention on themselves, limiting their capacity to focus on activities outside
of themselves. The extent to which individuals can focus on work whilst feeling unwell is largely
due to their personal level of resilience and tolerance.
This paper focuses on psychological distress arising in work however caused with origins at home
or at work, including distress caused by physical ill health.
Diverting attention and concentration away from the outside world towards internal sensations
can also come about because of boredom, mismatch of skills, knowledge and experience needed
to complete tasks, as well as the activities of others that may not accord with internal beliefs and
values of the individual affected, such as bullying, harassment, shouting and rudeness.
The beliefs and values of the individual are a central element of the Psychological Contract that is
the unwritten and silent agreement between the employee and the employing organisation and
its controllers based on a personal sense of fairness. The sense of fairness is based on personal
beliefs and values, and is, also, idiosyncratic. One person can be resilient to and tolerate rudeness
in others because rudeness doesn’t feature as a challenge to their personal beliefs and values,
whilst to others rudeness may be a challenge to a core belief on the grounds that rudeness masks
a whole range of other unacceptable forms of behaviour that combine together to create an
adverse event – an activating event that any individual might trigger for any reason.
Individual response to events, such as rudeness and diagnosable illness, is key to the sense of
personal wellbeing and presents a major challenge to organisations that wish to eliminate the
high costs attributable to sickness absence, staff turnover and presenteeism (the phenomenon
of people working but under-performing whilst feeling unwell due to ill health, psychological
distress or threats to wellbeing, such as fear).
The relationship between wellbeing and performance is on the ability of individuals to apply their
skills, knowledge and experience to a task in a way that absorbs their concentration and energy.
If concentration is interrupted or personal energy is directed towards self preservation then
performance falls off. This is the basis for much of presenteeism, the total costs of which are
about 58% of all costs attributable to staff sickness absence, turnover and presenteeism
Presenteeism is a massive challenge to all organisations. For many managers and employees
presenteeism occurs as a step towards sickness absence which may be a step towards turnover,
where the reason for turnover is disengagement with the current employer, and engagement
with an alternative or no employer.
Presenteeism and dis-engagement are linked. Engagement has been described as ‘a positive,
fulfilling, work-related state of mind that is characterised by vigour, dedication and absorption’.
Vigour is characterised by ‘high levels of energy and mental resilience whilst working, and
willingness to invest effort in one’s work, and persistence in the face of difficulties’. Dedication
refers ‘to be strongly involved in one’s work and experiencing a sense of significance,
enthusiasm, inspiration, pride, and challenge’. Absorption is characterised by being ‘fully
concentrated and happily engrossed in one’s work, whereby time passes quickly and one has
difficulties with detaching oneself from work’.
Dis-engagement, therefore, is the opposite of engagement and is the principal feature of
presenteeism where people come to work but under-perform because they cannot concentrate
on their work effectively, and are dis-engaged with their work and/or their organisation.
The standard solutions
There has been a spate of advice since early 2008 arising from a significant number of reviews
relating to health and wellbeing. Amongst them are:
Mental Health and Work – March 2008. Royal College of Psychiatrists.
‘Going the extra mile’ July 2008. Institute for Employment Studies.
Staff Engagement in the NHS. Briefing no. 50 November, 2008. NHS Employers.
Improving health and work: changing lives. November 2008. DoH/DWP
Improving working lives in the NHS. July 2009. DoH.
NHS Health and Wellbeing Review – Interim Report. August 2009
NHS Mutual. Engaging staff and aligning incentives to achieve higher levels of
performance. 2009. The Nuffield Trust
Psychological Health and Wellbeing: a new ethos for mental health. November 2009. BPS.
NHS Health and Wellbeing. Final Report. November 2009.
Promoting Mental Health through productive and healthy working conditions. November
New Horizons in Mental Health. November 2009. DoH
Much of the advice offered in these reviews can be interpreted within the standard therapeutic
framework of the ABC model where A is the activating event that causes ill health and/or
psychological distress, B is the belief, values and physiology that influence individual response to
the adverse event and C is the consequential behaviour and outcome that arises from the
individual response. The therapeutic intervention is often to support the individual at B by either
applying psychological therapies such as Cognitive Behaviour Therapy (CBT) or Acceptance and
Commitment Therapy (ACT) or bio-medical interventions. The role of Occupational Health
Services is frequently advocated in this context as are the services of Employee Assistance
Programmes, General Practitioners and Counsellors. The interventions are designed to modify
the individual response to the events so that the C – consequence –is that the individual remains
in work or returns to work.
However, this approach does little to address the massive challenge of presenteeism.
The HSE/CIPD report on ‘Manager Competencies for preventing and reducing stress at work’ in
2008 and The MacLeod Review – ‘Engaging for Success – enhancing performance through
employee engagement’ 2009 – come closer to addressing the fundamental issues relating to the
causes of psychological distress, presenteeism and under performance at work.
The MacLeod Review focuses on the importance of engagement in reducing costs attributable to
sickness absence and staff turnover, whilst the HSE/CIPD research emphasises the behaviours of
managers as moderators of sickness absence and staff turnover.
The X-Factor in wellbeing and performance
In their report ‘The Wellness Imperative: Creating more Effective Organisations’ (2010) the World
Economic Forum identifies the importance of embedding wellness strategies into organisation
strategies so that they become part of the bloodstream of daily organisational life. The report
shows the unambiguous link between wellness and productivity and performance.
This supports the approach set out in ‘Building Resilience – An Organisational Cultural Approach
to Mental Health and Well-Being at Work: A Primary Prevention Programme’ by Derek Mowbray
(2008) that promotes the building and sustaining of a Positive Work Culture as part of the
organisational strategy for all organisations to improve performance and eliminate the costs
attributable to sickness absence, staff turnover and presenteeism.
The key element is a focus on the cultural foundations and context within which people work. A
Positive Work Culture provides the context that promotes commitment, trust and engagement
between employees and their employing organisation. As everyone acts according to the
meaning of the situation they find themselves, a Positive Work Culture provides the meaning
most closely allied to commitment, trust and engagement, and this stimulates the behaviours
that actively promote the characteristics of commitment and trust.
These characteristics include:
Purpose that is clear, unambiguous and succinct.
Architecture that engages people in decision making about themselves.
Rules for recruitment, jobs, citizenship, life balance that promote commitment and trust.
Behaviours that promote encouragement, discretion, challenge, team working, support
and routine appraisal leading to commitment and trust.
The approach of building and sustaining a Positive Work Culture has a direct influence on how
individuals respond to activating events. If a cultural context has wellbeing and performance
embedded as part of the organisational strategy there is less risk of activating adverse events
occurring. Should such events occur, the individual response will be proportionate to the culture
that promotes commitment and trust. This furthers the opportunity for stronger engagement
between employees and their
The X-Factor in wellbeing and performance MAS employing organisations.
This is described as the XABC formula.
X = conteXt The XABC formula This places an emphasis on building
and sustaining a Positive Work Culture
A = activating event based on wellbeing and performance
(within the cultural context of the organisation)
principles, using commitment, trust
B = thoughts, emotions and behaviours and engagement behaviours. X is the
(reaction to activating event)
context within which managers are
C = consequential outcome expected to behave and is the cultural
(the manifested response to an event)
foundations for the organisation as a
whole. A is the activating adverse event and will be influenced in its type and severity by X; B is
the thoughts, emotions, values and behaviours that influence the reaction to the adverse event
and which is influenced by X, and C is the consequential behaviour and outcome from the
reaction to the event
Without the X-Factor in wellbeing and performance, all organisations will continue to employ
people who fall back on their own thoughts, emotions, beliefs and behaviours, encumbered by,
at best, a neutral, and at worst, a hostile, cultural context, to react to activating adverse events.
This is effectively allowing chaotic responses to take place, all of which will impair wellbeing and
performance amongst managers and staff – a feature of much of organisational life in the UK
today. A partial antidote to this is building and sustaining organisational and personal resilience
(www.orghealth.co.uk). A full antidote is to incorporate the X-Factor into organisational strategy.
The implementation process is based on the identification of the whole organisation and its
constituent organisations. Each organisation, whether large or small, needs to build its own
cultural context which is allied closely to that of the hosting organisation. Managers of the
constituent organisations need to be identified and developed in the behaviours that promote
commitment and trust.
The strategy of change that drives a change in culture is the strategy of conviction. This relies on
convincing managers and employees of the benefits of a Positive Work Culture and the relative
ease with which such a Culture can be built and sustained.
A Wellbeing and Performance Agenda can be agreed that incorporates:
Step 1 – is working with the top team of managers and non-Executive Directors. At this level the
focus is on reviewing and revising, as required, the purpose, architecture, rules and behaviour
expectations that form the cultural foundations for the organisation as a whole. This is part of
the organisational strategy, and will involve the identification of benefits to be accrued from a
Positive Work Culture.
Step 2 – is a survey of all managers and employees using the Quality of Working Life Assessment
(www.qowl.co.uk) to identify ‘hot spots’ and provide a benchmark against which changes are
Step 3 – is the preparation of a Manager’s Code (www.mas.org.uk) that sets out the behaviours
of managers in a) managing the organisation b) managing people and c) managing the business
Step 4 – is raising awareness of all managers and staff to the benefits and processes involved in
building and sustaining a Positive Work Culture and the adoption of a Manager’s Code.
Step 5 – management development of all leaders, managers and aspiring managers in all aspects
of a Positive Work Culture.
Step 6 – the provision of cognitive coaching for managers to help them re-align their thinking and
behaviour with the requirements of a Positive Work Culture based on wellbeing and
The relationship between wellbeing and performance is well established but inadequately
implemented in organisations. Consequently many organisations under-perform because they fail
to focus on eliminating the level of presenteeism that exists. Instead, most organisations provide
services in support of the ABC model of care, that helps individuals to respond to adverse
activating events by offering personal therapy, coping strategies, and other interventions to keep
people at work, or help them to return to work.
A more effective approach to the elimination of presenteeism is to be found in the XABC
formula. This formula places an emphasis on building and sustaining a Positive Work Culture that
will prevent presenteeism from being a drain on resources, and turn those who contribute to
presenteeism into high performing and engaged employees. The application of the XABC formula
to organisation strategy elevates the significance of wellbeing and its impact on performance,
leading organisational success.
For more information on building and sustaining a Positive Work Culture, and on the application
of the XABC formula please contact email@example.com
For more information on resilience training please see www.orghealth.co.uk
20th March, 2010