The most common assessment performed in Employee Health Promotion Programs is heart health assessment. The assessment can include a written heart health test, Blood Pressure measurement, cholesterol/HDL-cholesterol test, glucose (blood glucose), weight, educational materials specific to diet, nutrition, exercise, cholesterol, smoking, and weight. The health professional delivering the assessment then provides a consultation and helps set goals/objectives with the attendant.
The backbone of wellness programming at the worksite is health assessment. It is the first primary exercise a business ought to do when first starting a wellness program. Health assessment is often used in conjunction with the administration of a Health Risk Appraisal (HRA). The most effective way to screen is to utilize a health professional trained in wellness assessment techniques and counseling to privately and individually assess participants. This wellness professional takes a brief health history and measures Blood Pressure and cholesterol. With computerized cholesterol desktop analyzers, results are obtained in about four minutes. Immediate feedback, consultation, and educational materials are offered. For those identified at-risk, follow-up appointments can be scheduled at this time. The whole process takes about twenty minutes per individual. The screening also provides an immediate opportunity to register participants in various health improvement programs based on their interests and identified health risks. Health assessment can be done on an yearly basis and used as a means of monitoring health risks within the worksite. A health assessment program needs to offer multiple opportunities for participation. The service ought to be offered for all the various shifts of a business. The assessment program ought to be conducted in highly visible areas so the process can be observed. Reluctant employees often like to be able to see what the program is about before they participate. When wellness screeners are not busy, they ought to perform outreach going to areas where employees gather and attempt to recruit employees. When well-planned and promoted, health assessment can attract participation rates of 60% to 100%. These high participation rates have a positive influence on management producing backing for further programming.
Goals are broad-based statements about what the program is expected to do. The objective of the wellness program is to enhance the health of the individual and the business. Goals like mission statements offer direction in a program. Objectives are specific and provide a means of measurement of the program to determine performance. There are two types of objectives, process and outcome. Process objectives state the activities that need to occur to achieve a desired outcome. Examples of process objectives are:
Example of outcome objectives are:
Wellness committees are valuable in that they create a sense of ownership in the program, and facilitate various tasks involved in wellness programming at the worksite. The Employee Health Promotion Committee ought to be composed of a cross-section of employees representing various occupations, levels, and subgroups with the business. A common mistake is filling the Employee Health Promotion Committee with the most health/fitness-conscious people in the business. Don’t rely solely on volunteers to fill a Employee Health Promotion Committee. Make sure that your Employee Health Promotion Committee members have enough authority in the business to run an effective wellness program. The Employee Health Promotion Committee is made up of employees from the worksite. It oversees the wellness program and helps carry it out. The Employee Health Promotion Committee ought to meet about once a month to review the previous month’s activities and plan future ones. When the program is just starting, the Employee Health Promotion Committee may meet on a weekly basis until things get going. Committee members do not carry out healthcare procedures, counsel clients, or handle confidential health information. Wellness professionals perform these tasks. In general, the Employee Health Promotion Committee’s duties fall into three areas: planning, promoting, and supporting to run programs. Starting the programs can include:
Promoting the program can include:
Helping to run the program can include:
The size of the Employee Health Promotion Committee will be dependent on the size of the business. Pick members by asking day management to nominate or appoint employees. Make an announcement through handouts, memos, and meetings to recruit potential members. Explain the purpose of the Employee Health Promotion Committee, duties and responsibilities, and the time responsibility. Recognize your Employee Health Promotion Committee volunteers. Allow them to participate in programs at a reduced expense. Have appreciation breakfasts/lunches/dinners. Print names of Employee Health Promotion Committee members on business communications about the wellness program. Purchase special T-shirts, caps, and buttons for them. Write letters to supervisors saying that you appreciate the member’s service. Design awards certificates for members. The following can be used as a guide for Employee Health Promotion Committee size:
Effective wellness programs recognize the effect of building a supportive cultural environment. The worksite culture includes shared values/heartfelt beliefs about what is valuable. It includes social standards of expected and accepted behavior called “cultural norms.” It includes peer backing from family, friends, and co-employees. This backing can help one adopt healthy lifestyles. Tools are available to audit a business. The long-term success of any wellness program is dependent on the corporate culture. Some healthy culture signs in a business are:
Effective wellness programs attempt to create healthy worksite climates. A healthy worksite climate is one which encourages teamwork, cooperation, and empowerment of the individual. People have a sense of community, a shared vision, and a positive outlook. Policies encourage and support wellness efforts within the worksite.
An initial health assessment can include a survey of employees’ interests as part of the assessment. Effective wellness programs are designed to meet the needs and interests of the employees. The information you need to get from a survey depends on the scope of your program. A sample survey can be obtained in the HOPE Publications Web site. If you intend to adapt this sample survey or cultivate your own survey, keep the following hints in mind:
When thinking of who ought to get the survey, a simple rule is if you have under 500 employees, everyone ought to receive one. The public relations benefit of everyone receiving a survey can be valuable. Over 500 employees, a sample of the work population will suffice. A sample saves on costs and time. You may want to consider paying a statistician to determine the right sample size for your worksite. Needs surveys are confidential and anonymous; they do not request information that may identify a person. Getting backing from management is crucial to the success of the program. One way to do this is to survey managers (see forms) and conduct interviews with decision-makers in the business. You can use the surveys here or make up your own. If you decide to do your own, keep the survey short. It shouldn’t take more than ten minutes to complete. The interview process can also serve as a means of educating management. Provide concise fact sheets on the benefits of wellness programs for management. When surveys and interviews are completed, tally the surveys and write brief summaries of the interviews. Provide these reports to management. Once completed present a brief executive summary to management. Highlight a few interesting findings that can be used immediately to make decisions about the program. Utilize charts and graphs to make your points. Prepare a detailed report for Employee Health Promotion Committee members itemizing each response. Provide a short article about the survey in the business newsletter. The higher the response the more valid and reliable the results. A minimum response of 40% to 50% is acceptable.
Complete Employee Health Promotion Programs involve all employees, deal with all primary health risks, offers choices, and target both the employees and the worksite environment; offer periodic evaluation of its outcome. Complete Employee Health Promotion Programs emphasize follow-up and offers backing for the employee as long as he/she is employed. Research studies have shown this approach to be highly efficacious. Key components are planning, implementation, and evaluation. Starting inclusive Employee Health Promotion Programs involve performing a needs and interest assessment, appointing a Employee Health Promotion Committee, selecting wellness providers, setting goals/objectives for the corporate wellness program, marketing/promoting the program, and establishing procedures to ensure confidentiality. Implementation of inclusive Employee Health Promotion Programs consist of five primary tasks:
Assessment involves monitoring Employee Health Promotion Programs to find out if it is working and to help you refine it. Measuring success shows what you have achieved, helps justify costs, and provides information for management to support continued programming.
Initially introduced by Halbert Dunn in the 1950’s, wellness became a popular buzzword during the late 1970’s and received considerable academic attention in the 1980’s. Employee Health Promotion Programs for employees became more widespread during the following decade, and credible evidence for their economic viability began to be published. There have now been over 100 published research studies on this topic and a number of systematic reviews. Health risks aggravate costs. Healthcare Insurance costs escalate with both age and number of risks present.8,10 The number of risks is also strongly related to sick leave absenteeism, Worker’s Compensation costs, short-term disability, and reduced productivity (“presenteeism”). Early Employee Health Promotion Programs were relatively basic and typically produced a return on investment (ROI) of less than one dollar for every dollar invested operating the program (ROI = <1:1).8 Such programs might be characterized as “fun-oriented”. Participation is entirely voluntary, and there is no particular focus on the reduction of specifically identified elevated risks. Interventions and activities are not customized, and there is no emphasis on the management of health costs. These programs are typically site-based only, lack options to address all of the primary behaviorally-related health risks, and lack multimodal presentation. Minimal or no incentives are provided to employees for participation, and services to spouses and family members are not available. Most such programs lack meaningful evaluation. More conventional programs are “activity-oriented” and have shown an return on investment of between 1:2.5 and 1:3.5.8 These programs may have a greater emphasis on health and risk reduction, even though the efforts are relatively broad and not customized. They may have some generalized emphasis on health cost management, even though not necessarily aimed at specific elevated risks. Most are site-based and voluntary, with spouses included only rarely. Modest incentives may be utilized to advocate participation. Formal evaluation may be weak. The newest and most economically viable programs are “results-oriented” and exemplify the health and productivity management model. These programs consistently produce return rates of 1:4 or greater within a 12-24 month period.8 Such programs are strongly focused on the reduction of specifically identified elevated risks and the management of health costs. They are generally voluntary, but use strong financial and other incentives to encourage participation. They are multi-component in nature (address all primary risks), and have both worksite and virtual modalities of operation. The interventions are highly targeted and individualized, and available to spouses as well as employees. For organizations, the expense of providing medical insurance for their employees is of great effect. Those costs have been increasing at yearly rates between 6% and 14%. Chapman’s 2007 systematic review reported an average decline in healthcare costs of 26.5% as a result of Employee Health Promotion Programs. His review covered 60 of the most scientifically valid research studies, with an average of 3.77 years of study. Absenteeism due to illness is another cost driver. Chapman’s review reports an average decline in sick leave of 25.3%. Cost for Worker’s Compensation was reduced by 40.7%, and disability costs by 24.2%. There is also an emerging literature on the costs of presenteeism (reduced productivity).11,13 In one study, every risk reduced through a wellness program yielded a 9% decline in presenteeism (and a 2% decline in absenteeism). Some organizations have achieved a zero percent rise in healthcare costs across at least brief periods of time.10 Doing so requires 90-95% participation of the employee population in focused wellness pushes, with 75%-85% of the employees falling into the low risk category.10 Although robust efforts to decrease the risk status of those in moderate or elevated risk categories must be made, the needs of currently healthy employees must be addressed as well to avert increases in risk-status. Given the size of the federal workforce, valuable cost savings in the government’s contribution to medical insurance premiums for employees might be achieved if a majority of that population were participating in active wellness programs. Similarly, improvements in absenteeism, worker’s compensation, disability, presenteeism, and turnover as a result of robust Employee Health Promotion Programs would yield substantial fiscal benefits for the government. References
Corporation America is increasingly investing in employee wellness because it is great business. In order to meet productivity demands, organizations 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 Employee Health Promotion Programs, including reduced absenteeism, reduced injuries and workman’s compensation costs, reduced healthcare costs, reduced employee turnover, as well as better productivity, greater worker satisfaction, and improved morale.1-10 The more recent literature reflects improvements in wellness programming along with greater return on investment (ROI). In general, the more focused and intensive the program, the greater benefit realized. To enhance their performance federal government Employee Health Promotion Programs may be able to incorporate some of the features described. Employee wellness programs shown to have positive returns on investment often include the following features:
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, elevated cholesterol, high Blood Pressure, stress, depression, and so on. High-risk employees are specifically targeted for intervention, even though the most successful programs also direct efforts towards healthy employees in order to maintain their low-risk status. This model emphasizes outcomes as opposed to simply offering wellness activities for their own sake.
Use of a computerized health risk appraisal (HRA) instrument with individualized feedback and recommendations is almost universal in successful programs. Workers take the questionnaire annually in a myriad of cases. The HRA serves to broaden awareness, offer direction, and arouse people to better 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.
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, 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 often incorporate biometric data in their risk analysis.
employees are generally given monetary or other valuable 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 a myriad of cases the monetary incentives are associated with reductions in medical insurance premiums. Some programs use disincentives as well as incentives, such as charging employees who use tobacco higher rates for their medical insurance contribution.
Effective programs use incentives to drive participation rates up. They also market their programs extensively, and may use contest or challenge strategies to heighten enthusiasm and advocate participation.
employees with identified risks or desire to better their health habits may be periodically coached via telephone by trained health & wellness coaches. Wellness Coaching helps employees set and achieve realistic lifestyle-related goals/objectives including those approaching 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 employees with identified elevated-risk diseases.
Programs may offer wellness content in online, paper, and seminar formats to backing stimulating variety and alternatives in order to accommodate the needs of all employees. In addition to on-Site physical exercise and healthy eating programs, on-line programs, e-mail reminders and notices, printed newsletters and materials, and business classes are common dissemination strategies.
Enthusiastic and successive endorsement by upper management is vital to achieving high rates of participation. When senior executives are wellness role models themselves the effects of endorsement are enhanced.
Effective programs have successive 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 successive and multiple “touches”.
To advocate high participation rates employees must have simple access to the wellness programs and activities. Open and uncomplicated enrollment processes achieve this. Some organizations automatically enroll all employees and then allow those who do not wish to participate to “opt-out”. This practice has been shown to boost enrollment rates in some settings.
Many programs advocate spouses and other family members to participate in the business 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.
Because smoking and other tobacco use is the number one threat to health it is vital to offer employees effective and convenient assistance with stopping. Access to smoking cessation pharmaceuticals is often part of such programs. In-house programs offer the most convenient access to these services, even though on-line or telephone-based programs may be available as well.
Regular physical exercise is a core component of every wellness program. Workers 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.
Because obesity is a primary threat to health it is imperative that programs offer effective assistance with weight management. Enthusiastic encouragement from upper management to shed excess weight is valuable. Online programs, worksite programs, or discounted access to weight management programs in the area may all be available. Long-term follow-up is vital for maintenance of weight loss.
Workplace stress is perhaps the most common objection among employees and a primary contributor to absenteeism, presenteeism (reduced productivity), and low morale. Almost all successful wellness programs offer assistance with personal and worksite stress. Some programs refer employees to outside resources for more genuine conditions like depression and anxiety disorders, but most offer online or successive worksite general stress reduction programs. Some organizations endeavor to structure the work environment to minimize stress, both physically and operationally.
employees are actively encouraged to complete recommended healthcare screenings for Blood Pressure, cholesterol, BMI, colorectal and breast cancer, and others. Annual influenza immunizations are also encouraged. Some sites offer these services at the worksite. Incentives are often awarded for completion of these screenings/immunizations.
Actual provision of on-Site primary care medical services is a growing trend. The rapidly escalating costs of medical care insurance for employees has stimulated this trend. Some organizations have observed that it is less expensive to offer primary care services themselves than to fund those services through medical insurance. On-Site care also reduces the amount of time employees would otherwise spend away from the worksite getting such services.
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