Workplace stress is exacting an ever-higher physical and psychological toll. It adversely affects productivity, drives up voluntary turnover, and costs US employers nearly $200 billion every year in healthcare costs. Many companies are aware of these negative effects, and some have gotten busy devising ways to counteract them. Efforts range from initiatives to encourage sleep, exercise, and meditation to perks such as nap pods and snack bars.

In the midst of all this activity, it’s easy to overlook something fundamental: the work environment, starting with the work itself. For many years, a number of researchers, including myself, have touted the benefits of better work practices for performance and productivity. In my new book, Dying for a Paycheck (HarperCollins, 2018), I’ve tried to show how two critical contributors to employee engagement—job control and social support—also improve employee health, potentially reducing healthcare costs and strengthening the case for them as a top management priority.

In this article, I’ll explore the research that connects these two elements to employee health, and describe some examples of organizations that are succeeding at providing the autonomy, control, social connections, and support that foster physical and mental well-being. Any company, in any industry, can pull these levers without breaking the bank. Today, though, too few do.

Job control

Studies going back decades have shown that job control—the amount of discretion employees have to determine what they do and how they do it—has a major impact on their physical health. Recent research also indicates that limited job control has ill effects that extend beyond the physical, imposing a burden on employees’ mental health, too. Organizations can guard against these dangers by creating roles with more fluidity and autonomy, and by erecting barriers to micromanagement.

Physical and mental health

One of the most notable research efforts in this area was the Whitehall Studies, conducted by British epidemiologist Michael Marmot and his team, which examined employees within the British Civil Service. Marmot’s team discovered that the higher someone’s rank, the lower the incidence of and mortality from cardiovascular disease. Controlling for other factors, it turned out that differences in job control, which were correlated with job rank, most accounted for this phenomenon. Higher-ranked British employees, like higher-ranked employees in most organizations, enjoyed more control over their jobs and had more discretion over what they did, how they did it, and when—even though they often faced greater job demands.

Additional Whitehall data related work stress, measured as the co-occurrence of high job demands and low job control, to the presence of metabolic syndrome, a cluster of risk factors that predict the likelihood of getting heart disease and type 2 diabetes. Employees who faced chronic stress at work were more than twice as likely to have metabolic syndrome compared with those without work stress.

Other research has also found a relationship between measures of job control and health. A study of 8,500 white-collar workers in Sweden who had gone through reorganizations found that the people who had a higher level of influence and task control in the reorganization process had lower levels of illness symptoms for 11 out of 12 health indicators, were absent less frequently, and experienced less depression. And that’s far from the only example of job control affecting mental- as well as physical-health outcomes. For example, a study of individuals at 72 diverse organizations in the northeastern United States reported statistically significant, negative relationships between job control and self-reported anxiety and depression.¹

Learning, motivation, and performance

During my research, peoples’ stories painted a vivid picture of how low job control is all too common in many offices today. I heard much about the ever-evolving performance-evaluation criteria that made it tough to know how to succeed; the business trips rearranged without explanation; and even about a workplace “scout” who had to discern the boss’s mood and alert the others.

The picture isn’t pretty, and it can be costly. A chaotic workplace environment of frequent, uncontrollable events adversely affects people’s motivation, their cognition and learning, and their emotional state. If, through their actions, people cannot predictably and significantly affect what happens to them, they are going to stop trying. Why expend effort when the results of that effort are uncontrollable, rendering the effort fruitless?

That’s why research shows that severing the connection between actions and their consequences—leaving people with little or no control over what happens to them at work—decreases motivation and effort. It significantly hampers learning on the job, too. People’s ability to learn by observing the connection between actions and their consequences normally permits them to attain some degree of mastery over their environment—an understanding of what they must do to achieve the desired results. In a condition of low job control, on the other hand, people have less responsibility and discretion, which undermines their feelings of competence and accomplishment and ultimately contributes to stress, anxiety, and depression.

When you’re a child, the people in your life—teachers, parents—tell you what to do. As you get older, you begin to make your own life choices. And then one day, you get a job. Depending on your boss, your employer, and the design of your work, your choices about what to do and how to do it, at least while at work, can disappear—leaving you more stressed, more vulnerable to ill health, and, sometimes, less than yourself. There are some straightforward actions companies can take to avoid creating such an environment.

Guard against micromanagement

Micromanaging is all too common at work, simply because many managers are poor at coaching and facilitating others to do their jobs better. When managers micromanage their subordinates, those individuals lose their autonomy and sense of control to the bosses who won’t delegate.

Work doesn’t have to be this way. The founder of Patagonia, Yvon Chouinard, thought of the company as a place where “everyone kind of knows the role that they need to do, and does that work independent of extreme management.” He leads using a principle he calls “management by absence.” The company reduces the risk of micromanagement by having a flat organizational structure, with more people than any manager could possibly micromanage even if he or she wanted to. Similarly, at Zillow, as a learning-and-development person there put it, “the manager’s role is to support the team and be there to help remove roadblocks, not to be the dictator.” The head of human resources at Landmark Health agreed, saying, “If somebody feels like the work that they’re doing is not valued, if they personally don’t feel like they have a voice at the table, if they feel like they’re dictated to or micromanaged, they’re going to feel less fulfilled and more tired.”

Incorporate more autonomy and fluidity into every role

People often believe that providing job control is possible only for some jobs, and for some people. But that is not the case—all people can be given more decision-making discretion in their jobs and latitude to control their work. San Francisco–based Collective Health designed the jobs of its “patient advocates”—who answer the phones to resolve customer issues that aren’t readily solved—with a simple goal in mind: create a more empowered, highly skilled call-center staff, drawing graduates from top universities. As Andrew Halpert, senior director of clinical and network solutions, explains, “The typical profile is someone who majored in human biology and maybe wants to pursue a medical career, but meanwhile wants a job and to work for an interesting start-up. Then you say, ‘How are you going to keep smart people engaged and happy and not burnt out and dissatisfied?’”

Collective Health trains its hires thoroughly on key technical tools, while regularly rotating their physical locations and assigned tasks: one week they may be coordinating benefit issues, and the next solving larger issues outside their department, giving them an overall picture of how everything works. They are continually empowered to solve problems on the floor as they discover them, connecting with other teams in the company. The system has not only increased employee retention by providing people with more interesting and impactful work, it has also proven more efficient at resolving problems. Halpert says the benefits outweigh the extra costs for the company and the customer: “On the ‘how much did I pay?’ criterion, it looks more expensive. . . . The Collective Health call costs more because it’s being handled by someone who is better qualified and better paid who is also spending more time resolving the issue. But we solve problems, unlike other systems where claims and problems just go on with a life of their own.”

The Collective Health experience shows how roles can be designed both to improve people’s health and increase effectiveness for the benefit of employers—in fact, the two can be mutually reinforcing. Jobs that provide individuals more autonomy and control serve to increase their motivation, job satisfaction, and performance—while at the same time making employees healthier and helping them to live longer.