Introduction:Employer-sponsored health insurance covers over 60% of the U.S. population under age 65 and represents a significant expense for employers, yet employees' views on benefit design remain understudied. Methods:We conducted a nationally representative survey of 1200 U.S. adults using employer-sponsored insurance to assess preferences for benefit trade-offs, including narrower provider networks. The survey used stratified sampling and weighting to ensure demographic representativeness. Results:Nearly half (49.9%) preferred retaining the current balance of salary and benefits. However, 45.9% would accept a narrower network in exchange for higher compensation, and 30.9% supported narrow networks if savings were redirected to other benefits. Trade-off preferences varied by age, sex, race, parental status, and political ideology. Most respondents (74.8%) trusted employers to select plans and believed any cost reductions should be returned to employees (72.0%). Many also supported excluding high-cost providers without demonstrated quality advantages. Conclusion:The findings suggest that employees are open to cost-efficient plan designs if savings are shared transparently, although other data suggest that few employers are doing this.

Employers purchase health benefits for more than 60% of the nonelderly population, making employers both important custodians of employee well-being and important actors in the health care ecosystem. Because employers typically have unilateral control over health and retirement benefits, the federal Employee Retirement Income Security Act (ERISA), enacted in 1974, imposes fiduciary obligations on employers when they manage or administer benefits. We provide evidence, from a novel survey of respondents who administer or oversee health benefits for their companies, that many employers appear to neglect even the most basic of their fiduciary obligations to their employees. This neglect may help explain the poor performance of employer plans in controlling costs and providing access to health care, and it suggests that many employers may be vulnerable to liability from ERISA lawsuits.

Ambition, an individual trait that we show to be empirically distinct from the Big Five dimensions of personality, has been under theorized and researched as an important determinant of both career success and unethical behavior. We argue that the specific goals or focus of ambition, as well as the level of general ambition, are important. Study 1 used a large sample of working adults and found that general ambition and extrinsically-focused ambition were associated with a willingness to engage in political behavior and career success. Study 2 surveyed a second sample of working adults and found that extrinsic ambition was associated with an increased tendency to misrepresent qualifications when applying for a job. In Study 3, using four distinct scenarios, we found that extrinsic ambition was associated with people's willingness to engage in unethical behavior. The data make the case that ambition is an important trait useful for understanding people's careers and that there are at least two forms of ambition. Moreover, like some other personal traits such as narcissism, ambition can be a double-edged sword, associated both with career achievement and being willing to take ethical shortcuts to achieve success.

Because employers provide health benefits to >50 % of the working age U.S. population, benefits managers at companies who purchase and potentially oversee design and delivery of health benefits have an important role in affecting healthcare delivery. We sought to assess how companies measure and manage health benefits, because these dimensions of accountability affect the performance of the health ecosystem. We randomly sampled companies and obtained data from >200 people knowledgeable about health benefits administration in their organizations. Our novel survey comprehensively inquired about what data concerning health benefits operations companies collected and who, if anyone, was responsible for aspects of employee benefits experience and outcomes. We found a surprisingly small amount of accountability for employer-provided health benefits. For instance, 39 % of companies never requested any feedback from their employees about their health benefits, just 6 % assessed the time employees spent getting questions about their health benefits answered, and <5 % of companies measured how often employees postponed filling a prescription or seeing a doctor because of cost. Moreover, there was a widespread absence of accountability for the performance of health plans. On average, 64 % of 15 health benefits performance dimensions were managed by no one, and more than half of respondents reported that no one in their organizations was held accountable for either the physical (64 %) or emotional (59 %) wellbeing of the workforce. Companies mostly provide minimal oversight of the health plans they provide to their employees. This lack of accountability is inconsistent with employers' responsibilities to effectively manage the benefits they provide and almost certainly contributes to the well-documented problems of employee dissatisfaction with third party health benefits administrators and the frustration and wasted time spent accessing care and reimbursement that occasionally results in care delayed or denied, with consequences for both behavioral and physical health.

Importance Few studies have examined the extent to which employers emphasize financial over nonfinancial criteria in measurement, reporting, and decision-making about health care benefits. Objective To measure and identify factors associated with financial over nonfinancial emphasis in employer decision-making about health benefits. Design, Setting, and Participants A survey was administered to a nationally representative sample of US employers to assess the extent of employers' emphasis on benefits plans' costs over member experience, access to care, and equity, and on financial vs other considerations when choosing third-party benefits administrators. The sample included in-company human resources administrators from randomly selected nongovernmental organizations with at least 50 employees. The survey was administered in 2 waves: May 2022 to July 2022 and November 2022 to April 2023. Exposure The survey included 41 multipart questions capturing information about the respondent, company, company interactions with benefits consulting firms and benefits administrators, and company approach to managing employee health benefits. Main Outcomes and Measures Main outcomes were proportion of financially oriented measures that internal benefits administrators and external benefits consultants use and importance of financial vs other factors in companies' choice of third-party administrators. Results Of 1159 companies sampled, 251 (22%) responded; 30 with less than 50 employees were excluded. Of the 221 remaining companies, 147 (67%) used a benefits consulting firm. The companies and their benefits consultants focused on financial over nonfinancial performance dimensions in decision-making. While 125 companies (74%) tracked trends in health benefits costs and 109 (64%) tracked spending on the highest cost cases, only 14 (8%) tracked time employees spent having questions answered, and 12 (7%) tracked how often employees delayed receiving care because of an insurance company's actions. This financial focus was largely independent of organizational characteristics and other potential explanatory factors. Of 37 paired differences comparisons in the proportion of financial vs nonfinancial items, only 6 proportions (16%) differed significantly, with differences in proportions of 0.22 or less. Conclusions and Relevance In this survey study, US employers emphasized financial over nonfinancial criteria in their measurement and decision-making about health benefits. To improve health plan performance, employer measurement and decision-making must emphasize both nonfinancial and financial criteria.

Background:Within the past decade, digital coaching programs (DCPs) have emerged as an evidence-based modality to improve mental well-being and emotional intelligence (EI), although there is limited evidence in real-world contexts. Objective:This pragmatic retrospective cohort study aims to determine the preliminary effectiveness of a DCP in improving mental well-being and EI within a real-world context. We hypothesized that there would be a significant increase in mental well-being and EI. Methods:This study included 588 people who voluntarily enrolled in an 8-week, blended care DCP offered through their employers from October 2021 to August 2024. The DCP included routine check-ins and consultations with certified coaches. Participants completed the World Health Organization-Five Well-Being Index (WHO-5) at baseline and then weekly until the end of the program, as well as the Brief Emotional Intelligence Scale-10 (BEIS-10) at baseline and the end of the program. Multivariable linear mixed models examined changes in WHO-5 (biweekly) and BEIS-10 (pre-post) scores, adjusting for age, gender, program engagement, and program completion. Multivariable logistic regression models evaluated correlates of clinically meaningful improvements on the WHO-5 (ie, at least a 10-point improvement). We calculated a reliable change index (RCI) for the BEIS-10 and the proportion of participants meeting the RCI criterion from baseline to end of treatment. Results:In multivariate linear mixed models adjusting for demographics and program characteristics, we observed a significant increase in WHO-5 scores (baseline x¯=45.6; week 8 x¯=66.3; Cohen's d=1.98; P<.001). Over half of the sample (55.4%) experienced a clinically meaningful improvement on the WHO-5. Multivariable logistic regression found that higher engagement was associated with an increased odds of a clinically meaningful improvement on the WHO-5 (adjusted odds ratio [aOR] 1.002, 95% CI 1.001-1.003), while program noncompletion (aOR 0.27, 95% CI 0.15-0.50) and higher baseline well-being (aOR 0.91, 95% CI 0.89-0.92) were associated with reduced odds. BEIS-10 scores also significantly increased from baseline to the end of the program after adjusting for relevant correlates (baseline x¯=37.6; week 8 x¯=41.2; Cohen's d=1.32; P<.001). The estimated RCI on the BEIS-10 was approximately 5, with 19.7% experiencing a meaningful improvement. Conclusions:These results demonstrate that DCPs can be a viable option for individuals looking to improve their mental well-being. Additional efforts should focus on establishing reliable change metrics for EI measures. Studies using hybrid effectiveness-implementation trial designs are now needed to further evaluate the real-world effectiveness of this program.

Though organizational scholars have studied punishment for decades, recent examples of punishment in organizations cannot be fully explained by the scholarly literature. This may be because much of our prior understanding of punishment has been based on studies in highly bounded organizations, but with the shift to remote work arrangements and contract or freelance work, modern organizations are becoming increasingly boundaryless. Does punishment in bounded organizations look different than punishment in boundaryless organizations? To answer this question, we review and categorize the literature on punishment in organizations according to the boundedness of the organization it examined. We find that though there are similarities in punishment in bounded and boundaryless organizations, punishment in boundaryless organizations involves different actors, punishing different situations, for different reasons, using different methods. However, many questions about punishment in boundaryless organizations remain, including about the pervasiveness, motivations, and impacts that punishment has in boundaryless organizations.

The relative scarcity of policy-relevant research is the inevitable result of editorial policies pursued by most if not all of the highest status management and organization science journals. Ironically, there are a plethora of policy-oriented journals available as publication outlets, so it is possible to both publish and read policy-relevant scholarship, just not in the usual places. These facts pose a challenge to traditional journals, including those published by the Academy ofManagement.

Policymakers are regularly named as one of the targeted audiences of management research. However, Aguinis, Jensen, and Kraus (in press) found that policy implications are underutilized and not part of organizational behavior and human resource management’s zeitgeist because only 1.5% of the articles (i.e., N = 61) from a sample of journals included such issues. Consistent with the conference theme, the goal of our panel symposium is to discuss how together we create a better world—specifically by using management research for policymaking. To achieve this goal, our symposium includes panelists who are purposefully diverse in terms of research interests, ontological perspectives, and geographic location (i.e., combined, they are members of more than 10 different AOM Divisions). As such, panelists will address issues of interest to both micro and macro management researchers, and those from a range of disciplinary backgrounds. Again, the symposium will have both a past and a future orientation. Regarding the past, panelists will address existing research and theories that can be used for policymaking to create a better world; what worked, what did not work, and the limits and possibilities for reviving and renovating past policy options. We can certainly learn from policy successes and failures in the past, at the same time as considering novel policy options at firm, social, economic and governmental level in the future. Regarding the future, panelists will also address what research should be conducted (i.e., which topics, theories, types of research designs) so that results are useful for firm and societal policymaking that will result in creating a better world. Overall, we hope our symposium will serve as a catalyst for a better understanding of what types of management research-informed policies are useful for creating a world in which we will all be better off together.

Objective:To understand the consequences of employee volunteering and possible psychological mechanisms that produce these effects.Methods:Using data from more than 50,000 responses to Britain's Healthiest Workplace survey, we employed structural equation modeling to investigate the effects of people volunteering.Results:Net of a number of controls, people who volunteered reported better self-reported health, less risk of depression, and higher levels of engagement and satisfaction. These results were partly explained by volunteering creating higher levels of interpersonal social bonding and greater identification with their employers.Conclusion:Employers Employers should sponsor volunteer activities and provide workplace flexibility, because employees who volunteer have greater individual wellbeing and also higher levels of pro-employer outcomes such as engagement and job satisfaction.

Forty-five years ago, power as a topic was mostly absent from management textbooks and courses, including executive education teaching, in the fields of business and public administration. This was the case notwithstanding the fact that power dynamics are invariably present in most public and private sector workplaces. Research demonstrates that power affects resource allocations among departments and other subunits as well as decisions on strategic direction in organizations of all types. Research also shows that power affects people´'s career trajectories, including their salaries and the hierarchical levels they attain.

The empirically related psychopathologies of stress and depression exact an enormous economic toll and have many physical and behavioral health effects. Most studies of the effects of stress and depression focus on their causes and consequences for a single, focal individual. We examine the extent to which depression, as indicated by filling antidepressant prescriptions (SSRI and Benzodiazepines), co-occurs across spouses, constituting a negative spillover effect. To better understand the conditions that affect within-household contagion of depression, we examine whether the stress and uncertainty occasioned by job change and financial stress (net worth) increases spillover effects among spouses. We use panel data from various Danish administrative registers from the year 2001-2015 with more than 4.5 million observations on more than 900,000 unique individuals and their spouses from Danish health registers. Spouses in a household with their partner using antidepressants have a 62.1% higher chance of using antidepressants themselves, with the one year lagged effect being 29.3% and a two-year lagged effect of 15.1%. The effects become larger by 14.8% contemporaneously and 20% in the two-year lagged model if the focal individual changed employers. There was also a substantively unimportant effect of lower financial wealth to increase inter-spousal contagion.

Recently there has been a burgeoning literature on leaders who exhibit grandiose narcissism, Machiavellianism, and manifestations of psychopathology. Two important findings are that these "dark-triad" leaders are reasonably common because the traits predict leader emergence, and that the traits are associated with harm for organizations and their members. The juxtaposition of commonality and harm seemingly challenges assumptions about performance-enhancing organizational adaptations and begs the obvious question of why and how psychologically toxic individuals can rise to and remain in powerful positions. I argue that labels applied to leaders implying darkness or dysfunction divert attention in unproductive ways from the benefits of these traits and bias research findings. I present arguments as to why many people readily choose what research suggests are psychologically problematic people to follow. Fixing the many leadership crises besetting modern societies requires more attention to why people rise to positions of power and, more controversially, teaching people to embrace, rather than shun, behaviors and tactics that actually create power and career success. If power is to be used for good, good people need to know and willingly use the tools of power, even if, or possibly particularly if, such tactics are also used by their opposites.

Research has shown that grandiose narcissists often rise to positions of power in organizations, even though there is little evidence that they perform better. Indeed, some studies show various deleterious effects on both their companies and the people who work for them. Prior research suggests that one reason for narcissist's success is that they are more skilled at organizational politics. One plausible implication is that narcissists are more willing to use a broad range of power tactics, in part because research shows that narcissists are less prone to feeling guilt for their behaviors. Using a sample of fully-employed adults (n = 270), we show that narcissism is correlated with a greater willingness to use tougher, more aggressive political tactics, an effect that is stronger to the extent that people are less guilt prone. Because research shows the importance of political skill for career success, our findings help account for why narcissism may produce more favorable career outcomes.

Research over the past decade has shown that grandiose narcissists are often successful at attaining leadership positions in organizations. However, there is no evidence that narcissists lead higher performing firms, and while they see themselves as more competent leaders, there is no evidence for this, either. In fact, research shows that narcissistic leaders have numerous negative effects on the entities they lead. This raises a question: Why are narcissists so successful in attaining leadership positions? We suggest that the defining characteristics of grandiose narcissism (grandiosity, self-confidence, entitlement, and a willingness to exploit others for one's own self-interest) may make them more effective organizational politicians than those who are lower in narcissism. We report the results of three studies that show: (1) those higher in narcissism are more likely than those who are lower to see organizations in political terms (opportunity), (2) they are more willing to engage in organizational politics (motive), and (3) they are more skilled political actors (means). We discuss the implications of these results for organizational dynamics and career processes.

Companies often benefit from others’ attributions of moral conviction for prosocial behavior, for example, attributions that a company has a sincere moral desire to improve the environment when behaving sustainably. Across four studies, we explored how organizations’ changing resource positions influenced people’s attributions for the motivations underlying prosocial organizational behaviors. Observers attributed less moral conviction following prosocial behavior when they believed an organization was losing (vs. gaining) economic resources (Studies 1 and 2). This effect was primarily a “penalty” assessed against organizations that were losing resources, as opposed to a “reward” given to organizations gaining resources (Study 3). Finally, we found that this effect occurred because people perceive organizations that are losing resources as more situationally constrained, leading them to attribute less dispositional moral conviction (Study 4). We discuss theoretical and practical implications stemming from how changes in resource access can lead people to be more skeptical of organizations’ motivations following prosocial behavior.

Objective: Employers affect the health of employees and their families through work environments and employee benefits. We sought to understand employer decisions around those topics. Methods: Interviews with 21 executives from diverse, purposely-sampled, progressive companies with transcripts analyzed using inductive and deductive methods. Results: Companies often viewed keeping employees healthy primarily as a means to profitability rather than an end in itself and rationalized stressful workplaces as necessary and non-changeable. Many possible actions including job redesign and changing benefits administrators were seen as infeasible. Even large, resource-rich organizations were strikingly non-agentic. Conclusions: Companies seem less committed to the goal of increasing employee health than they claim or than they should be, given the significant relationship between employee health and economic performance, and see external and internal barriers to improving health that are often self-created.

Academy of Management DiscoveriesVol. 6, No. 1 Commentaries“Crying Wolf”: A Comment on Dahl and Pierce and a Suggestion on Using (Danish) Prescription DataJeffrey PfefferJeffrey Pfeffer1Corresponding author.Stanford UniversityPublished Online:2 Apr 2020https://doi.org/10.5465/amd.2019.0095AboutSectionsView articleView Full TextPDF/EPUB ToolsDownload CitationsAdd to favoritesTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail View articleREFERENCESBebbington, P. E., Brugha, T. S., Meltzer, H., & Jenkins, R. 2000. Neurotic disorders and thereceipt of psychiatric treatment. Psychological Medicine, 30(6): 1369–1376. Google ScholarClougherty, J. E., Souza, K., & Cullen, M. R. 2010. Work and its role in shapingthe social gradient in health. Annals of the New York Academy of Sciences, 1186(1): 102–124. Google ScholarDahl, M. S. 2011. Organizational change and employee stress. Management Science, 57(2): 240–256. Google ScholarDahl, M. S., Nielsen, J., & Mojtabai, R. 2010. The effects of becoming an entrepreneur on the use of psychotropics among entrepreneurs and their spouses. Scandinavian Journal of Public Health, 38: 857–863. Google ScholarDahl, M. S., & Pierce, L. 2020. Pay-for-performance and employee mental health: Large sample evidence using employee prescription drug usage. Academy of Management Discoveries, 6(1): 12–38 (https://journals.aom.org/doi/10.5465/amd.2018.0007).Abstract , Google ScholarFox, M. 2018. Major depression on the rise among everyone, new data shows. Available at https://www.nbcnews.com/health/health-news/major-depression-rise-among-everyone-new-data-shows-n873146. Accessed November 28, 2019. Google ScholarGoh, J., Pfeffer, J., & Zenios, S. A. 2016. The relationship between workplace stressors and mortality and health costs in the United States. Management Science, 62(2): 608–628. Google ScholarKivimaki, M., Virtanen, M., Vartia, M., Elovainio, M., Vahtera, J., & Keltikangas-Jarvinen.L. 2003. Workplace bullying and the risk of cardiovascular disease and depression, Occupational and Environmental Medicine, 60: 779–783. Google ScholarMoussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. 2007. Depression, chronic disease, and decrements in health: Results from the world health surveys. Lancet, 370(9590): 851–858. Google ScholarPfeffer, J. 2018. Dying for a paycheck. New York: HarperBusiness. Google ScholarPierce, L., Dahl, M. S., & Nielsen, J. 2013. In sickness and in wealth: Psychological and sexual costs of income comparison in marriage. Personality and Social Psychology Bulletin, 39(3): 359–374. Google ScholarRobbins, J. M., Ford, M. T., & Tetrick, L. E. 2012. Perceived unfairness and employee health: A meta-analytic integration. Journal of Applied Psychology, 97(2): 235–272. Google ScholarWilliams, D. R., Neighbors, H. W., & Jackson, J. S. 2003. Racial/ethnic discrimination and health: Findings from community studies. American Journal of Public Health, 93(2): 200–208. Google ScholarWulsin, L. R., Vaillant, G. E., & Wells, V. E. 1999. A systematic review of the mortality of depression. Psychosomatic Medicine, 61: 6–17. Google ScholarFiguresReferencesRelatedDetailsCited byMagnitude and Effects of “Sludge” in Benefits Administration: How Health Insurance Hassles Burden Workers and Cost EmployersJeffrey Pfeffer, Dan Witters, Sangeeta Agrawal and James K. Harter29 October 2020 | Academy of Management Discoveries, Vol. 6, No. 3When Is an Effect Size Too Small? Response to Commentary on “Pay-for-Performance and Employee Mental Health”Michael S. Dahl and Lamar Pierce2 April 2020 | Academy of Management Discoveries, Vol. 6, No. 1 Vol. 6, No. 1 Permissions Metrics in the past 12 months History Received 10 March 2019 Accepted 16 March 2019 Published online 2 April 2020 Published in print 1 March 2020 Information© Academy of Management DiscoveriesKeywordsprescription datamental healthpay-for-performanceDownload PDF