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The employer commissions the service and if they want to get the best value from it then they do need to promote it. But equally the EAP need to promote it, to justify their existence.” (Participant 9) “We have a benefit fair every year, and we get them to come in, and this is one of the reasons I had to change my account manager, because we would always ask them to do some kind of talk, but my ex-account manager would not really inspire anyone to do anything…” (Participant 3) HR Managers also discussed the difficulty in communicating the fact that EAPs were more than just a support line for those with mental health issues, and that other services (which could have an impact on an employee’s mental health) were also available. In interviews the strong connection between EAPs and mental health was evident, with HR Managers inferring that the EAP was mentioned when employees were about to take ‘sick-time off’, and realised that they ‘may not get to promote the other services as much as they would like’.
“I mean, for me the EAP is more than just purely counselling. I do think that the EAP can be tarnished with a counselling brush, and I do think that is to do with how the service is promoted. So I do my absolute upmost to ensure the employees know that there are distinct aspects to EAPs and that it is not purely about counselling.” (Participant 6) A few of the HR Managers we spoke to highlighted that in some organisations there could be cultural issues which led to employees struggling to understand that accessing help is ok, both in the UK, and in organisations who had sites in other countries. They recognised that this was a difficult barrier to overcome. One HR Manager suggested that the name ‘EAP’ may not encapsulate all the
services that EAPs provide, and the term could be off-putting for some staff members:
“The EAP may need to change its name, because I think it’s just got to become a little more approachable. The term is off-putting. It is not clear what the service provides, and when you call something a ‘programme’ it makes you think like you are in some kind of system and are not going to get out any time soon.” (Participant 3) In this way, ideas for improvements to EAP promotion included regular proactive promotion of the service, instead of just reactive measures (for example managers highlighted that the EAP number was in return to work letters after a period of sickness absence, but recognised that more should be done earlier), ensuring that reminders of the EAP are sent to all staff and not just given to those going through inductions, EAPs should be given more prominence in team meetings and should be talked about instead of just having posters around the building.
The regularity of reminders was often discussed, with one HR Manager observing that she now has the EAP number and a short blurb around EAP service provision in her email signature, so it is always there when e-mails are sent. One interviewee discussed the role of ‘wellbeing champions’ – members of staff interested in wellbeing to promote wellbeing initiatives across the organisational service areas. It was noted that there needed to be more champions with clearer objectives, but these could potentially improve the promotion of EAPs. Finally, both the survey and interviews were conscious that the message had to be accessible for ‘harder to reach staff’, including those who hot-desk, work flexible hours, who do not work in an office (examples given included rubbish collectors, street wardens) and those who work from home, but who are still eligible for EAP use.
EAP Evaluation Having understood how and why the service is used by employees, the research was keen to determine whether any evaluations of EAPs were undertaken to measure the quality of the service provided. Out of the 45 respondents who answered whether they measured the EAP quality of service, 60% responded positively, 31% indicated that they did not measure the quality, and 9% did not know. There were a number of methods through which organisations measured service quality, the most common being staff ratings (59%), the number of closed cases (56%) and sickness absence (37%).
Does your organisation measure EAP quality of service?
Other methods of EAP evaluation included having quarterly meetings with providers to discuss performance, and what improvements could be made, reviewing the usage reports across the different modes of service provision (face-to-face, telephone and website use), and one organisation also measured the retention of staff who had used the service.
However, the qualitative interviews provided a lot of information regarding EAP evaluation and the difficulties associated with conducting evaluations. The majority of those interviewed reported that any evaluation was probably more ‘ad-hoc’ in its approach, and was heavily reliant on the quarterly feedback forms and meetings that they had with their service provider.
HR Managers indicated that usage reports could be tailored to individual organisations on request of specific information, however the information usually requested included: statistics regarding service use, mode of use (e.g. if someone had accessed the website what area of the website they had used, or which areas of the website have been accessed most frequently), gender, age, organisational division and whether follow ups were necessary.
“We probably don’t evaluate our EAP properly, we do monitor the usage, but this really isn’t an evaluation…We can only measure how important and how good the service is to our employees by our usage figures, and I get these from my provider monthly… and when people want to know what the usage is then I can tell them. They give me everything that I ask for.” (Participant 3) Another method of evaluation came from the feedback forms that providers ask service users to complete after having received the help required from their EAP however, there seemed to be a wide range of levels of feedback collected, and differences in how reliably participants would answer them. One interviewee revealed that their provider asked a number of valuable
questions that could help with service evaluation:
“There are a number of specific questions that they [the EAP] ask for those who have used the service. These include, did the EAP help you? Did you feel better at the end of the sessions? Do you feel better enough to carry on working? Did using the EAP enable you to carry on working without going off sick? So we get a lot of evidence from these questions which are self-reported from those you use it.” (Participant 9) When asked whether organisations had ever considered undertaking their own evaluations, HR Managers often responded that although it would be helpful to see what employees thought of the service and whether it could be improved, asking employees to evaluate the service was difficult as the topic was sensitive in its nature, and there could be a breach in the confidential nature of the service, as only those who have used the services would be able to answer. For a minority of interviewees, developing a way in which the service could be evaluated more comprehensively whilst maintaining confidentiality was something to be included when they
renewed the contract:
“It is hard to do, because you don’t know who you are targeting…there is the confidentiality of the service, so unless the manager has actually referred the person to the EAP, then we don’t know who is using it…so we can’t evaluate it formally.” (Participant 8) Anecdotal feedback was the main way through which HR Managers were able to find out what employees thought of the service and this was offered as having some form of organisational evaluation. Managers found that users were often happy to report when they had experienced a positive service from the EAP, which often happened through day to day conversations. In some cases, knowing that employees had had a positive experience was a helpful way to promote the service to others. Managers also said that they welcomed any complaints about the service,
although these were few and far between, and these could be used to improve EAP delivery:
“We have some anecdotal feedback from people who have actually accessed the programme, so if they have had a good experience, then occasionally they would come to us and say that they have found this really good and useful. We certainly encourage this because it helps us to know that the EAP is providing the right service, and what the staff need from the programme.” (Participant 4) However, HR Managers understood that this form of feedback would not be able to provide the data that they needed to ascertain whether having used the EAP had been beneficial for reducing sickness absence and improving employee productivity. In many cases, it was not because managers did not want to conduct evaluations, but they saw difficulties in measuring the benefits of EAPs, both
because some of the outcomes were intangible and because as one manager noted:
“I think we can say that when people contacted them [EAPs] they were probably already at a high, or medium to high level of anxiety, or you know, in that state of mind, and therefore when they have reached the support, or been through the support mechanism, you would just expect their anxiety to reduce anyway, so the expectation is already there.” (Participant 7) Financial Evaluation One of the objectives of the research was to review whether organisations examine the cost utility of EAPs, or investigate a return-on-investment to see what wider value EAPs can provide to employers and employees. Results from the quantitative survey found that out of the 44 respondents who answered the question, only 9% had conducted return-of-investments, 86% had not and 5% did not know. Has the organisation conducted a Return-on-Investment calculation for the EAP?
Has the organisation conducted a Return-on-Investment calculation for the EAP?
Number of Respondents Yes No Don't Know The qualitative interviews provided a greater insight into the importance (or seemingly lack of importance) of conducting an economic evaluation of EAPs in organisations. None of the HR Managers interviewed for this research conducted any financial evaluation, and there were a variety of responses as to why this was the case. The most common response offered by participants was that managers were under no pressure by the senior management team or finance directors to provide evidence of cost-effectiveness or return-on-investment. In many cases having an EAP was seen as the ‘right thing to do’, and cost was therefore not a point of interest.
“I have not been asked to do a financial evaluation or return on investment. I think that the EAP is just a good service to have, so we don’t have to justify it. It is an intangible benefit to staff, so it is really hard to put a value on the service that it provides.” (Participant 10) “No we don’t do financial evaluations. We don’t have to justify the EAP usage as everybody sees it as something, as a benefit if you like, for staff to access, and it has never really been questioned at all since it has been here…the EAP is seen as an essential commodity for staff… it’s a question of the value for the people that use it.” (Participant 2) For some HR Managers the logistics around conducting financial evaluations were discussed, including the difficulties in identifying a robust and meaningful methodology through which return-on-investments can be conducted, and some even asked during the interviews if there was any known methods that other organisations have shared through which such calculations can be made. Others commented that the usage reports they received from service providers did not contain all the relevant information that was needed to calculate any financial evaluations, and although some ‘assumptions’ could made, the evaluative methods would not be rigorous enough.
“Do we check that we are getting an ROI? No. Because I think that you will find that if you speak to anybody, finding an ROI for wellbeing programmes is very difficult. You can resort to the method that if you have certain things in place then theoretically you are saving x amount of money from people not going off sick, but that is a very difficult thing to do…I would love to say what an ROI is, but there is no real way to be able to measure that at the moment that is robust enough to be meaningful.” (Participant 1) If assumptions regarding return-on-investments needed to be made, HR managers often spoke about using sickness absence data as an indication of improved health and wellbeing, alongside engagement survey findings. One manager described how the feedback that the provider gave them indicated that savings have been made as they would have reported in their usage reports ‘x number of staff used this service, and x said that they would not have to take sickness absence because they had used the service’. However, for one HR Manager, basing return-oninvestment or conducting any financial evaluation of an EAP based on sickness absence data
was not an option for them:
“I have not done a cost-benefit analysis or anything like that, because that would be tied up with sickness absence, and I said that I did not want the EAP to be measured against sickness absence because that it is just so difficult to measure that…I don’t know how that can be directly related to the service. I am not going to look at absence levels because they can vary for many reasons, for ill-health, for all the different life factors.” (Participant 6) Although the organisations did not conduct any financial evaluations, phrases such as ‘we use EAPs because they are cost-effective’, or ‘EAPs are cheap’ were often given as benefits to the service. When questioned how HR managers could say this when no financial evaluations are
undertaken, a variety or answers were given, including:
• that EAPs are cheaper in comparison to other talking therapies that organisations looked into:
“If we were going to provide this talking therapy differently, than it would cost a lot more, and that is how I can say it is cost-effective. So it is not about how much we could have saved in sickness absence, it is more about thinking how we could have provided the service differently, and I see it as cost-effective in that way.” (Participant 9)