Posts from — June 2009

Employer America is increasingly investing in employee wellness because it is good business.  In order to meet productiveness demands, corporations must rely on a healthy, constructive workforce to succeed in the highly competitive global marketplace.  Over a hundred research studies in both corporate and governmental settings have documented the economic benefits of Company Wellness Programs, including reduced absenteeism, reduced injuries and workman’s compensation expenditures, reduced medical expenditures, reduced employee turnover, as well as enhanced productiveness, greater worker satisfaction, and improved morale.1-10  

The more recent literature reflects improvements in wellness programming along with greater return on investment.  In general, the more focused and intensive the program, the greater advance realized.  To enhance their success federal government Corporate Wellness Programs may be able to incorporate some of the features described.  Employee wellness programs established to have beneficial returns on investment often include the following features:

1.   Health and productivity management model
Programs characterized by this model focus attention on identification and reduction of specific risks or behaviors such as smoking, lack of physical exercise, excess weight, unhealthy diet, high cholesterol, high Blood Pressure (BP), stress, depression, and so on.  High-risk workers are specifically targeted for intervention, although the most successful programs also direct efforts towards healthy workers in order to maintain their low-risk status.  This model emphasizes outcomes as opposed to simply offering wellness activities for their own sake.  

2.   Health risk appraisal
Use of a computerized health risk appraisal (HRA) instrument with individualized feedback and recommendations is almost universal in thriving programs.  Employees take the questionnaire annually in many cases.  The HRA serves to expand awareness, provide direction, and innervate people to improve specific behaviors.  In some cases, the customized report is directly linked to appropriate resources related to identified risks.  Research indicates that the use of an HRA is effective if it is followed by some kind of educational or therapeutic intervention for identified risks.  It often serves as the entry point into wellness programs.

3.   Health Screening
Many programs combine the outcome of the health risk appraisal with measurement of each employee’s biometrics, including weight and Body Mass Index (BMI), Blood Pressure (BP), cholesterol, fasting glucose, and assorted other metrics.  Combining the results of the HRA with biological measures results in a more accurate risk profile.   Computer health risk appraisals frequently incorporate biometric data in their risk analysis.

4.   Incentives
employees are commonly given monetary or other significant rewards for completing an HRA, participation in a program or class, specific accomplishments such as stopping smoking, losing weight, or exercising, and for maintaining healthy status and/or behaviors.  In numerous cases the monetary incentives/rewards are associated with reductions in health care insurance premiums.  Some programs use disincentives as well as incentives/rewards, such as charging employees who smoke higher rates for their health care insurance contribution.

5.   High participation rates
Successful programs use rewards and incentives to drive participation rates up.  They also market their programs extensively, and may use contest or challenge strategies to heighten enthusiasm and encourage participation.

6.   Wellness coaching
workers with identified risks or desire to improve their health habits may be periodically coached via telephone by trained health and wellness coaches.  Wellness Coaching helps workers set and achieve realistic lifestyle-related objectives and goals including those discussing stress, work life balance, smoking, weight, physical exercise, and various behavior modifications.  Three or more sessions are generally available.  In some intensive programs, the coaching extends to actual disease management intervention for workers with identified elevated-risk diseases.

7.   Multiple formats
Programs may offer wellness content in online, paper, and seminar formats to provide stimulating variety and alternatives in order to accommodate the needs of all staff members.  In addition to on-Site physical exercise and healthy eating programs, on-line programs, e-mail reminders and notices, printed newsletters and materials, and employer courses are common dissemination strategies.

8.   Senior Management reinforcement
Enthusiastic and successive endorsement by senior staff is critical to achieving high rates of participation.  When senior executives are wellness role models themselves the effects of endorsement are enhanced.

9.   Frequent contact
Successful programs have persistent contact of some sort with every employee.  This may be through marketing efforts (e.g., posters, e-mail notices, reminders, or messages, etc.), bulletin boards, newsletters, employee meeting presentations, discussion in new employee orientation, supervisory sessions, etc.   The key is to enhance employee awareness of wellbeing and health opportunities and reinforce the corporate emphasis on wellness through persistent and multiple “touches”.

10.   Open enrollment
To advocate high participation rates employees must have easy access to the wellness programs and activities.  Open and uncomplicated enrollment processes achieve this.  Some corporations automatically enroll all employees and then allow those who do not wish to take part to “opt-out”.  This practice has been demonstrated to boost enrollment rates in some settings.

11.   Family involvement
Many programs advocate spouses and other family members to participate in the organization wellness activities and to adopt a healthy lifestyle along with the designated employee.  It is far easier for the employee to have a healthy lifestyle if his/her family does so as well.

12.   Smoking cessation
Because smoking and other tobacco use is the number one threat to health it is essential to offer employees effective and convenient assistance with stopping.  Access to smoking cessation pharmaceuticals is frequently part of such programs.  In-house programs support the most convenient access to these services, although on-line or phone-based programs may be available as well.  

13.   Exercise
Regular physical exercise is a core component of every wellness program.  Employees must be strongly encouraged to engage in regular physical exercise.  Most programs provide either periodic or continuous worksite opportunities, and some locations have worksite gyms, swimming pools, walking trails, etc.  Discounted or paid memberships to area exercise facilities is a common alternative to worksite facilities.

14.   Weight management
Because obesity is a major threat to health it is imperative that programs offer effective assistance with weight management.  Robust encouragement from management to shed excess weight is significant.  Internet based programs, worksite programs, or discounted access to weight management programs in the community may all be available.  Long-term follow-up is vital for maintenance of weight loss.

15.   Stress management
Workplace stress is perhaps the most common objection among workers and a primary contributor to absenteeism, presenteeism (reduced productivity), and low morale.  Almost all thriving wellness programs offer assistance with personal and workplace stress.  Some programs refer workers to outside resources for more weighty conditions like depression and anxiety disorders, but most offer online or persistent worksite general stress reduction programs.  Some employers endeavor to structure the work environment to minimize stress, both physically and operationally.

16.   Health screenings/immunizations
workers are actively encouraged to complete recommended healthcare screenings for Blood Pressure (BP), cholesterol, BMI, colorectal and breast cancer, and others.  Annual influenza immunizations are also encouraged.  Some sites support these services at the worksite.  Incentives are frequently awarded for completion of these screenings/immunizations.

17.   Onsite health care
Actual provision of onsite primary care medical services is a growing trend.  The rapidly escalating expenditures of medical care insurance for staff members has stimulated this trend.  Some companies have found that it is less expensive to offer primary care services themselves than to fund those services through health insurance.  On-Site care also reduces the amount of time staff members would otherwise spend away from the workplace getting such services.

References

1.   Aldana, Steven G.  (2001)   Financial Impact of Worksite Wellness Programs:  A Comprehensive Review of the Literature.   Am J Health Promotion 15(5):296-320.
2.   Chapman, Larry.  (1998)   The Role of Incentives in Health Promotion.  The Art of Health Promotion  2(3):1-8.
3.   Chapman, Larry.   (2003)   Biometric Screening in Health Promotion:  Is it Really As Important as We Think?  The Art of Health Promotion  7(2):1-12.
4.   Chapman, Larry.  (2005)   Meta-Assessment of Corporate Health Promotion Programs Economic Return Studies: 2005 Update.  The Art of Health Promotion, July/August, 1-15.
5.   Chapman, Larry.   (2006)   Employee Participation in Corporate Wellness Programs and Corporate Wellness Programs:  How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6):  431-432.
6.   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   The Role of Health and Wellness Coaching in Corporate Health Promotion Programs.   The Art of Health Promotion, July/August, 1-12.
7.   Chapman, Larry.  (2007)   Proof Positive:  An Analysis of the cost-Effectiveness of Worksite Wellness.  Northwest Health Management Publishing, Seattle, WA.
8.   Chapman, Larry.  (2007)   An In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
9.   Edington, Dee.   (2001)   Emerging Research:  A View from One Research Center.  American Journal of Health Promotion 15(5): 341-349.
10.   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
11.   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Work Productivity.   Journal of Occupational and Environmental Medicine, 46(7): 746-754.
12.   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of comprehensive Health and Disease Management Programs at the Worksite: Update VI 2000-2004.  JOEM 47(10)1051-1058.
13.   DeVol, Ross, Bedroussian, Armen, et. al.  (2007)  An Unhealthy America:  The Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.
14.   Partnership for Prevention.  (2008) Investing in Health:  Proven Health Promotion Practices for Workplaces.   http://www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.

Evaluations determine the outcome of a Employee Wellness Program. They help you learn if your objectives were met. It is a great idea to add an evaluation component to your Employee Wellness Program.

Evaluations may conclude that some interventions didn’t work well. You may discover that a popular Worksite Wellness Program costs too much and didn’t really affect employees’ health. While these may not be the outcomes you hoped for, without this information you might continue ineffective interventions. Having this information will help you cultivate better solutions. When your results are good, it’s magnificent! You can spread the word to workers and management that your program is achieving its goals/objectives.

Three primary areas of an evaluation

• Workplace Health Promotion Program structure – The basic framework of the program
• Worksite Health Promotion Program process – How well the program is run
• Employee Wellness Program outcomes – Whether the program met the set objectives

Common questions used to evaluate a Employee Wellness Program

Corporate Health Promotion Program Structure Questions

• What is included in the Company Wellness Program? What is the intervention?
• Where does the Worksite Health Promotion Program take place?
• How is the Workplace Health Promotion Program delivered? What content is included?
• Who manages the Employee Health Promotion Program?

Corporate Health Promotion Program Process Questions

• How many people participate?
• Do participants complete the Corporate Health Promotion Program?
• Are participants satisfied?
• Which aspects of the Company Health Promotion Program are best attended?

Employee Wellness Program Outcome Questions

• Does the Worksite Health Promotion Program better knowledge about health concerns?
• Does the Workplace Wellness Program modify behavior?
• Does the Company Wellness Program save the company money?
• What is the return on investment (ROI)?

• Determine through an employee survey what incentives/rewards they value.
• Determine what rewards and incentives the company can provide as well as what the budget will allow.
• Be sure that every colleague who achieves a objective receives some recognition.
• Avoid offering incentives and rewards for the “best” or the “most.”
• Avoid using food as a reward.
• Use rewards and incentives to reward your Employee Health Promotion Program, through logos and branding.

Incentives promote staff members to adopt beneficial behaviors or maintain an existing beneficial behavior that may potentially help the employee stay healthy and live longer. Adopting beneficial health behavior is fundamentally what wellness is about.

Incentives can be used to improve participation rates, help people complete a Worksite Wellness Program, or help people modify or adhere to healthy lifestyles. Providing incentives and rewards and rewards will send an important message to the staff members that your company is committed to assisting them with improving their health. It also plays a important role in motivating people to take part.

Tips on how to choose appropriate incentives/rewards:

• Determine through an employee survey what incentives they value.
• Identify what incentives and rewards the company can provide as well as what the budget will allow.
• Make sure that every attendant who achieves a intention receives some recognition.
• Avoid offering incentives/rewards for the “best” or the “most.”
• Avoid using food as a reward.
• Use incentives and rewards to encourage your Employee Wellness Program, through logos and branding.

When beginning a accross the board Employee Wellness Program, make sure that it consists of a variety of awareness, lifestyle shift, supportive environment programs, policies and activities that target risk behaviors, and the needs and interests of the workers. It will be important to review and revise existing policies governing such areas as smoking sections and the employee cafeteria.

Tips on starting a Worksite Wellness Program:

• Design activities based on your planned objectives addressing the specific needs of your staff members. Focus on those issues that are of greatest interest to your staff members and the greatest needs of your corporation, in that order. Avoid issues with narrow appeal.
• Keep it simple. Design the Employee Wellness Program so it’s easy for the participants to be aware of and track.
• Integrate a combination of activities to include awareness, educational, and behavior elements.
• Select activities in which every employee can take part.

Recommendations for your Corporate Health Promotion Program:

• Challenges. Activities that focus on practicing a desired behavior that continues for 4-8 weeks and focuses on specific topics (such as physical exercise, diet, or stress management).
• Learning experiences. This includes courses, videos, and classes.
• Behavior changes (such as smoking cessation). You may or may not offer interventions at the worksite. Nevertheless, you should bolster people to make lifestyle changes that they want to make even without an external incentive.
• Education on disease management. For example, support and education groups for diabetes, high Blood Pressure, etc.
• Learing new skills. For example, CPR and first aid.
• Preventive screenings like Blood Pressure, cholesterol, and vision.

Source: Adapted from the Building Healthy Texans Job Site Wellness Toolkit.

Create objectives

Goals are general instructions that explain what you want to achieve. Objectives define strategies or steps to take to attain the identified objective.

A wellness program ought to have a “destination”. Use the results of your surveys and your wellness committee’s mission statement as guides. Consider these ideas:

• Focus on making health information and learning resources readily available to employees
• Focus on group activities so workers can work together to support and encourage healthier lifestyles
• Establish a wellness program that is visible to both staff members and to your customers
• Focus on written policies and guidelines
• Set objectives for your wellness program.

Review Guidelines for Writing Goals.

Goals Should Be

Specific – A goal is specific when it provides a description of what will be accomplished. It will state exactly what the organization intends to accomplish. It should be written so that it can be easily and clearly communicated. A specific goal will make it easier for those writing objectives and action plans to address the following questions:

• Who is to be involved?
• What is to be accomplished?
• Where is it to be done?
• When is it to be done?

Measurable – A goal is measurable if it is quantifiable. To determine if your goal is measurable, ask questions such as: How much? How many? How will I know when it is accomplished?

Attainable – You can attain most any goal you set when you plan your steps wisely and establish a time frame that allows you to carry out those steps. Goals that may have seemed far away and out of reach eventually move closer and become attainable.

Realistic – Realistic, means “do-able.” The intention needs to be realistic for your organization and where the organization is at the moment. A intention to take out all the high fat items in the snack machines may not be realistic for your organization right now; a better intention would be to substitute some of the chips, candy bars and pies for pretzels, yogurt and dried fruit.

Timely – Finally, a objective must have a timeframe: for next week, in three months, by age 35. It must have a starting and ending point. It ought to also have some intermediate points at which progress can be assessed. Limiting the time in which a objective must be accomplished helps to focus effort toward its execution. If you do not set a time, the commitment is too vague. It tends not to happen because you feel you can start at any time. Without a time limit, there’s no urgency to start taking action now.

Effective wellness programs are designed to meet the needs and interests of the employees. Ask employees what they are interested in, and what needs they have. People are more willing to participate and support wellness efforts if they are involved in the decision-making process.

When creating a survey, keep the following hints in mind:

• Ask mostly closed form questions, especially if you will be sending the survey to a big number of employees. Closed form questions provide specific choices and are simple to tabulate.
• Invite comments, opinions and recommendations, or ask open-ended questions at the end of the survey. Open-ended items are more difficult to summarize.
• Include a brief explanatory cover letter with the survey with the signature of the corporation president. Make sure to include a statement about confidentiality and anonymity.
• Ask a group of representative workers to review the survey before it is distributed. Find out if the questions will be understood by workers and won’t be objected to.
• Include demographic information at the beginning, or end of the survey (gender, age, shift, site, department, etc.).
• Conduct a random drawing for a valued incentive item for all those who returned the survey. This could improve the response rate.

One rule to consider concerning surveys is if you have fewer than 500 workers, everyone ought to receive one. The benefit of everyone receiving a survey can be significant. If you have over 500 workers, a sample of the work population from each department will suffice. The higher the response, the more valid and reliable the results. A minimum response of 40 percent to 50 percent is considered significant.

A essential first step in organizing your company’s wellness program is the formation of a Workplace Health Promotion Program Committee. The focus of the Workplace Health Promotion Program Committee is to plan, reward, and start the program. The Workplace Health Promotion Program Committee establishes continuity, motivation, and broad ownership of the program as well as provides an great vehicle for communication.

So who ought to be on the Worksite Wellness Program Committee? Consider appointing the following people/departments to your Worksite Wellness Program Committee:

• Senior Leadership within your employer
• Union representatives
• Human resources department
• Employee Assistance Program
• Information technology
• Communications
• Health and safety department
• employees interested in health & wellness

Building a efficacious Worksite Wellness Program requires employee time as well as money. Some larger businesses may spend 20 hours per week for three to six months preparing all the steps prior to kicking off a Worksite Wellness Program.

Anywhere from 4 to 10 people meeting monthly equals a Employee Wellness Program Committee. A mission statement for the Employee Wellness Program Committee ought to be developed by the second meeting. This way, everyone knows what the Employee Wellness Program Committee is working toward.

Once a wellness program has been established, the committee’s size and meeting schedule may differ. Still, no fewer than 4 members ought to meet at least quarterly so the group – and the wellness program – does not fade away.

Support from senior staff is essential to building a successful wellness program! Visible senior staff reinforcement is one of the most vital factors in the success of a workplace Worksite Health Promotion Program. Upper Management executives are responsible for making sure that the employer meets its objectives. They can provide additional assistance by helping you to link your Worksite Health Promotion Program objectives to employer outcomes, thereby positioning Worksite Health Promotion Program as a fundamental part of the employer.

It is significant to create support and excitement for the program from all echelons of the company including upper management, mid-level management, and grass-root employees.

The challenge for any Corporate Health Promotion Program coordinator is convincing management about the potential value of Corporate Health Promotion Program to the organization and conceptualizing how Corporate Health Promotion Program pushes can effect the organization in a meaningful manner. The American Journal of Health Promotion is a great resource to assist you with obtaining convincing information on the benefits of a Corporate Health Promotion Program.

Worksite Health Promotion Program reinforcement from management can come in many different ways:

• Involvement in the wellness program planning process
• Distribution of funding for the wellness program
• Support for time given to the wellness program
• Participation in wellness programs
• Administration by management, such as the distribution of a letter of reinforcement for the program.
• Flexibility of employee schedules to accommodate wellness activities

The first step in planning your wellness/Employee Health Promotion Program is to know your organization and how Employee Health Promotion Program will fit into the current structure. By researching your organization’s history with similar programs and eliciting feedback from co-workers, you can learn the best solution for your organization.

Worksite Health Promotion Program: Research Questions

• Find out if Workplace Wellness Program has been done in the past. If so, what worked and what did not?
• Was it widely accepted?
• Was programming thriving? Why or why not?
• What does your organization hope to gain from launching a Workplace Wellness Program?

Answers to these questions will help you begin the process of creating a culture of wellness within your employer. It is imperative that you assess the environment before starting a program.

The costs of health care have been rising more than 10 percent each year for several years. A substantial amount of the money invested in the health care system treats costly illnesses and diseases.

• Approximately 95 percent of the $1.4 trillion that we spend as a nation on health goes to direct health care services, while about 5 percent is allocated to preventing disease and promoting health.
• Potentially, 50 percent to 70 percent of all diseases are avoidable as they are associated with modifiable health risks.
• In an effort to optimize employee health, cut avoidable medical utilization and enhance work execution, and in turn reduced medical expenditures and improve employee satisfaction and retention, many businesses are beginning, or are interested in beginning, Employee Health Promotion Programs for workers.

The advantages of workplace wellness are well documented. Greater than 120 research studies repeatedly show themes such as improvements in health outcomes coupled with high returns on investment (ROI). Some major findings include the following:

• Savings of $3.48 in reduced health care expenditures per dollar invested.
• Savings of $5.82 in reduce absenteeism costs per dollar invested.
• ROIs of at least $3 to $8 per dollar invested within five years of program implementation.
• Lifestyle behavior modification programs: $3 to $6 return on investment within 2 to 5 years.
• Self care, decision reinforcement programs: $2 to $3 return on investment within a year.
• Disease management programs: $7 to $10 ROI within a year.

By offering health improvement programs, employers are not only providing an additional service for employees, but they are also gaining fiscally. Furthermore, the effect of a health improvement program goes beyond decreased medical cost and ROI. A health improvement program can affect work rate, absenteeism, morale, recruitment success, turnover, and medical costs.

• Source: Rees, C., and Finch, R. (2004). Health Improvement: A comprehensive guide to beginning, implementing and evaluating workplace programs. National Business Group on Health, 1 (1), 1-7.