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Book:  Dying for a Paycheck

Author:  Jeffrey Pfeffer

Purchase:  Print | eBook | Audiobook

Citation: Pfeffer, J. (2018). Dying for a paycheck : how modern management harms employee health and company performance--and what we can do about it. New York, NY: HarperBusiness, an imprint of HarperCollins Publishers.

Three Big Takeaways:
  1. According to the Mayo Clinic, the person you report to at work is more important for your health than your family doctor. (pg. 9)

  2. Companies seem to believe there is some inevitable trade-off between offering health insurance benefits that benefit their people and saving money and keeping costs low to increase their profits. This choice is a false one. Keeping employees healthy is completely consistent with economic performance. (pg. 95)

  3. Companies vary dramatically in their work hour policies, even companies operating in the same country and in the identical industry. Work time is the result of managerial decisions and discretion. There is a long-hours culture in some workplaces; long hours are used even when they are not needed. Many people see putting in long hours as demonstrating commitment and loyalty to the employer and the job. (pg. 125)


Other Key Ideas:​

50 percent of the employers in the US with more than 50 employees and 92 percent of employers with more than 200 employees offered some sort of wellness promotion program in 2009. However, only 24 percent of employees at companies that offer a wellness program actively participate in it. Furthermore, the difference in health-care costs between people who participated in wellness programs and those who did not was just $157 annually. (pg. 29)

The US spends $7662 per person on healthcare (2.6x the average) and devotes 16.9 percent of its GDP to healthcare (1.8x the average). Nonetheless, the US ranks just 27th for life expectancy and 53rd in infant mortality. (pg. 33)

A surprisingly large fraction of the US workforce, even people with health insurance, report delaying or not receiving medical care because of costs. In 2015, almost one in three Americans delayed medical treatment in the prior year because of the cost. Moreover, people who put off obtaining medical care because of costs were more likely to say they did this for a serious condition than for a non serious one. Even when people get care, they may face stress and have to expend time and energy dealing with their health insurers to get costs reimbursed. (pg. 94)

While people of color comprise 34 percent of the US population, they account for 52 percent of the people without health insurance. (pg. 102)

Not-portable pension benefits are one source of "job-lock," and one of the purposes of deferred compensation schemes such as pensions is to tie employees more tightly to their employers, thereby reducing turnover costs. Employees will therefore stay at employers where they are no longer interested because they are afraid to lose their pension or the health benefits if they enter the labor market and don't find a job right away. (pg. 110)

It is estimated that administrative overhead (marketing, reviewing claims, adjusting appeals, etc.) consumes almost one-third of US health-care spending, and this large administrative burden is one reason why the US spends so much on health care without achieving better outcomes. One growing employer response is to offer health care on-site. This not only reduces the enormous overhead burden, but also permits employers to get closer to their employee's health issues earlier in the process. On-site health care saves travel time for employees (thus reducing sick time) and can be a cost savings. As of 2007, 23 percent of surveyed employers with more than 1,000 employees reported offering on-site medical services. (pg. 114)

About one third of American employees do not use all the vacation days to which they are entitled. A more recent survey indicated US workers leave a median of seven vacation days unused. About a quarter of Americans do not get any paid vacation at all. (pg. 124)

Decades ago, leisure time was a marker of social class. A tan meant you could afford to take a nice vacation, and beach attire was a status marker. Today, higher-class, higher-earning individuals actually work more than their lower-income counterparts. In a perverse twist, longer work hours has become a status symbol - a marker of how important, indeed indispensable, someone is. (pg. 128)

Many companies have cultures that seemingly idolize long hours and forgone vacation. Most employers seek loyalty and commitment from their employees. They want employees who are willing to devote the extra effort required to triumph against the competition. It is, of course, difficult to directly observe someone's loyalty and commitment. It is much easier to assess indirect indicators of employee dedication, and the hours someone puts in on the job and whether employees use all their vacation time are two indicators. Employers also prefer longer hours because of the implicit belief that work output is related to the number of hours worked - the more hours, the higher the output. This relationship certainly holds for some sorts of jobs in the past where there was less technology, creativity, and mental concentration involved in production. Instead, for many jobs there comes a point at which output suffers from putting more time in. (pg. 129)

An absence of control reduces motivation. If people cannot predictably affect what happens to them, they are going to stop trying. Why expend effort when the results of that effort are uncontrollable. That's why research shows that when people with little or no control over what happens to them at work decreases motivation and effort. People want to make decisions and use their experience and skills at work. When people cannot make decisions and do not have sufficient control over their work, they are stressed and suffer ill-health. (pg. 152)

Research going back decades shows the job autonomy - the amount of discretion you have to determine what you do and how you do it - is one of the most important predictors of job satisfaction and work motivation, frequently ranking as more important than even pay. Job autonomy also positively affects job performance, in part by increasing motivation and partly by permitting people to use all their capacities and information to do the work in the best way possible. (pg. 157)

Holiday and birthday parties - almost anything that brings people into contact in a pleasant and meaningful context - helps build a sense of shared identity and strengthens social bonds. (pg. 168)

Few people want to admit to themselves or others that they aren't good at something, particularly if that "something" implicates their self-esteem. And for many people, work is integral to their self-concept and self-image. Particularly for people doing relatively high-prestige work, there is no price too high or circumstance too difficult to face - because the alternative is to admit weakness or failure. Toughing it out in impossible circumstances becomes something to be sought, to be able to demonstrate one's competence, energy, and dedication. (pg. 179)

Once people have made a decision, particularly if the decision is public and voluntary, that person is psychologically committed to the decision. That means the individual becomes identified with the choice and its implications and motivated to continue behaving in ways consistent with the decision. If we want to feel good about ourselves, we certainly don't want to admit we made a mistake or did something stupid. People will remain in a bad workplace and remain committed to their decision to work in a difficult work environment rather than admit they made a bad decision. (pg. 180)

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