Worksite Wellness ProgramsWorksite Wellness Programs

A organization plan is a roadmap for success. Use the guidelines below to develop a realistic organization plan and budget for your Worksite Wellness Programs.

What is a organization plan?
• A plan for success
• A document that convincingly demonstrates that your Worksite Wellness Program will help the organization to achieve its goals.

Questions to ask when developing a Worksite Wellness Program organization plan

• Why do you need to do the Worksite Wellness Program?
• What are you going to do?
• Where are you going to do it?
• Who is the target audience?
• How are you going to do it?
• Who is going to implement the Worksite Wellness Program?
• How much will the Worksite Wellness Program cost Upper Management?
• What is Upper Management going to get out of the Worksite Wellness Program? Why should Upper Management invest in the Worksite Wellness Program?

Worksite Wellness Program organization Plan Components

• Title and duration of the Worksite Wellness Program
• Points of contact
• Background information (description of need; bibliography/literature review; how the Worksite Wellness Program will help achieve the organization’s goals)
• Worksite Wellness Program description
• Goals and objectives
• Implementation site
• Target population
• Work plan
• Partnerships and collaborations
• Timelines and milestones
• Budget and resource requirements (dollars and workers)

Gaining the support of leadership

• Clearly link the Worksite Wellness Program goals and objectives to the organization’s strategic plan.
• Focus on the desired outcomes.
• Use the right language for the right audience. By way of example, Upper Management is interested in decreased clinic visits, increased provider productivity, management of the health of the population. However, Upper Management is interested in increased readiness, decreased lost duty/training time, and decreased disability and FECA claims.
A well thought-out Worksite Wellness Program organization plan will help you gain leadership support, help you get and keep resources needed to implement the Worksite Wellness Program, and keep the Worksite Wellness Program on track towards meaningful outcomes.

As they say: “timing is everything.” Use the guidelines below to guide the timing of Worksite Wellness Program activities and data collection.

Timing: Worksite Wellness Program Start-up

• Consider the optimal time to start a new Worksite Wellness Program. Take into account preferences of the target population and other factors that could affect enrollment and participation.
• By way of example, coordinating the start of an adult weight management initiative with the start of school in August or September may be a good tie-in with a “fresh start.”
• On the other hand, starting an adult weight management initiative In January may not be a great idea because of the constraints that weather may put on exercising outdoors.
• Take advantage of other timing cycles at your installation. Planning a marketing blitz just after the PCS turnover has been completed is a good way to let new personnel know what Worksite Wellness Program options are available.

Timing: Worksite Wellness Program Participant Support

• Consider how frequently Worksite Wellness Program sessions should be offered to provide the best support and education for participants and the best opportunity for success.
• Get feedback from participants regarding what session frequencies work best for them.
• Consider the timing for other support mechanisms like email encouragement. What timing of those messages will benefit participants most: Weekly? Bi-monthly? Monthly?

Timing: Worksite Wellness Program Data Collection

• Collecting data is an excellent way to track participant progress and also to identify potential problems within a Worksite Wellness Program. So, give some thought to the frequency and timing of data collection.
• Select metrics that can realistically change during the Worksite Wellness Program implementation time period. By way of example, BMI and weight may not change very much during a 10-week Worksite Wellness Program; however, step counts are more likely to noticeably change.
• Some data, such as participant responsiveness to out-of-class assignments (like food journals) and other interim data (like step counts) will provide important information needed to “adjust fire” as needed and make Worksite Wellness Program changes if something is not working.
• Be flexible regarding data collection frequency. Instead of requiring that participants complete an physical fitness log every day, for example, consider asking for a “snapshot” summary from two or three days during the week. You will still get information to review, but participants will have an easier time complying with the assignment.

Timing: Worksite Wellness Program Follow-up

• Because the we are such a mobile population, it’s best to plan some sort of post-Worksite Wellness Program follow-up data collection within two to four months after the Worksite Wellness Program ends.
• You can always try to collect additional follow-up data at 6 or 12 months after Worksite Wellness Program completion. However, if you collect the data sooner, you’ll at least have collected some short term Worksite Wellness Program impact information before participants are lost to follow-up.

Worksite Wellness Program communication is important to all aspects of Wellness and preventive medicine and is relevant to:

• Healthcare provider-patient relationships
• An individual’s exposure to, search for, and use of Worksite Wellness Program information
• Effective counseling and patient education for behavior change
• Content of public health messages and community campaigns

Effective health communication should have these attributes:

• Accuracy: content is valid and error-free
• Availability: delivered or placed where the intended audience can access the information
• Balance: content presents benefits and risks of potential actions
• Consistency: content is locally consistent over time and is also consistent with information from other reliable sources
• Evidence-based: content and methods of delivery are based on relevant scientific evidence
• Reach: content gets to or is available to as many workers as possible in the target population
• Reliability: content source is credible; content is kept up-to-date
• Repetition: delivery of/access to the content is continued over time, to reinforce the impact with the audience and to reach new members of the target population
• Timeliness: content is provided when the audience is most receptive to, or in need of, the specific information
• Understandability: reading, language levels, and format are appropriate for the specific audience (i.e., Employees, Family Members, Garrison leadership, etc.)

What the research says about health communication

• Health communication best supports Wellness when multiple communication methods are used to reach specific audiences.
• Effective Wellness and communication initiatives should reflect an audiencecentered perspective, and reflect the preferred formats, contexts, and way of communication for the intended audience.

Material adapted from: U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000.
http://www.healthypeople.gov/document/HTML/Volume1/11HealthCom.htm

Evaluation of successful Worksite Wellness Programs has revealed several key Worksite Wellness Program strategies to increase Worksite Wellness Program effectiveness and impact overall Soldier health.

Strategy #5: Using a small number of targeted priorities maintains Worksite Wellness Program focus.

• Needs assessment data can be used to identify leading health needs and also high risk populations.
• Choosing a handful of specific health needs on which to focus will maximize efficient use of resources.
• Keeping the Worksite Wellness Program focus small will avoid duplication of other ongoing installation Worksite Wellness Programs.

Strategy #6: Use standardized processes whenever possible.

Reduce the amount of variation within your Worksite Wellness Programs by standardizing all the processes needed for Worksite Wellness Program planning and implementation. By way of example:
• Use the same spreadsheet format for data collection so that the columns are in the same order. This way you can compare data more easily.
• Reuse the same forms for enrollment and attendance. Change the heading as needed.
• Look at other Wellness Programming processes (like registration, evaluation, marketing, etc.). What parts of those processes can be standardized?
• The Wellness and Prevention Initiatives website (http://chppmwww. apgea.army.mil/dhpw/Population/HPPiFunction.aspx) has many standardized Worksite Wellness Program resources in a variety of topic areas.

Strategy #7: Worksite Wellness Program delivery methods should be flexible and adapted to population needs.

• Delivery of products and services may depend on: unit needs, training requirements, other scheduling considerations (such as work/duty schedules, school scheduling, etc.), participant preference, and/or availability of staff or space.
• Be flexible: the same produce/service delivery methods may not work for every population.
• Some units may want services provided to them as close as possible to the unit location; other units may prefer as many services as possible bundled together at once (regardless of location).
• Take Wellness and preventive medicine beyond the walls of the organization in order to meet leadership and employee needs. Answer the question: “How can we best help leadership and Employees to fulfill their mission?”

Evaluation of successful Worksite Wellness Programs has revealed several key Worksite Wellness Program strategies to increase Worksite Wellness Program effectiveness and impact overall Soldier health.

Strategy #1: Communication with leadership is essential

• Assess leadership priorities.
• Report Worksite Wellness Program outcomes back to leadership in a timely manner.
• Equal investments of support from both the medical and line community will result in enhanced Worksite Wellness Program success.

Strategy #2: Worksite Wellness Program planning must be driven by data.

• Determine specific needs of the target population.
• Focus on the health status of the population as a whole to identify the top health concerns.
• Information should drive decisions regarding which health needs should be addressed first.

Strategy #3: Use electronic data collection and reporting as often as possible.

• Centrally collected data in an electronic format is essential for determining population health needs.
• Electronic reporting is also very valuable when communicating Worksite Wellness Program outcomes to leadership and other stakeholders.
• Flexible reporting capabilities allow data to be presented as information that can support decision-making, in formats that decision-makers prefer.

Strategy #4: Multidisciplinary collaboration enhances employee health and maximizes available resources.

• Collaboration between health disciplines increases effectiveness of Wellness and preventive medicine initiatives.
• Don’t forget to look outside the organization for collaboration partners.
• Optimized Worksite Wellness Program outcomes can be met by coordinating the activities of medical professionals, cadre, community agents, and funding sources.
• Bundling services together also provides the additional benefit to units by conserving training and mission time.
Implementing these strategies can improve Worksite Wellness Program effectiveness and optimize available resources.

Changing health-related behaviors is a difficult challenge. Incorporate the tools below into your Wellness initiatives to assist participants in successfully changing health behaviors.

Tool #1: Set effective goals

• Focus on areas that can impact the overall goal.
• By way of example, if the overall goal is to lose weight, the most productive areas to focus on are the dietary and activity changes that will lead to long-term weight loss.
• By way of example, stress management and improving self-esteem may also impact weight loss; however, improving relationships, while a worthwhile topic, will not necessarily impact weight loss.
• Make the goals specific, attainable, and forgiving. By way of example:
• “Exercise more” is too general.
• “Walk five miles everyday” is specific, but may not be attainable.
• “Walk 30 minutes everyday” is specific and more attainable, but is not very flexible.
• “Walk 30 minutes, five days a week” is specific, attainable, and forgiving.
• Use a series of short-term goals to achieve the ultimate goal.
• Short-term goals break big challenges into more easily attained pieces.
• Smaller steps also provide Worksite Wellness Program participants with encouragement and success. These small successes are essential for maintaining motivation towards a long-term goal.

Tool #2: Increase self-awareness

• Self-monitoring is useful for tracking behavioral and environmental cues that trigger a particular health behavior.
• Keeping track of health behavior status is also useful for times when progress towards a goal is difficult to measure, or when an individual is in a maintenance stage.

Tool #3: Offer rewards and motivation

• Encourage participants to reward themselves for achieving small successes on the way to their ultimate goal.
• Remember that rewards don’t always have to be “things.” Words of encouragement and praise can provide powerful motivation when spoken by a teacher, instructor, parent, friend, etc.

Tool #4: Respond effectively to set-backs

• health behavior change is conceptually a continuum. However, movement along that continuum is not just in one direction. People can move backwards or forwards or sometimes just stay put. Communicate to participants that set-backs, lapses and even staying the same (i.e., maintenance) are common for individuals trying to change behavior.
• Stress is often a factor in lapses and relapses. Offer a variety of stress management resources to help participants better handle the stress which could trigger a set-back.
• Brain storm to create a list of potential (and probable) barriers to participant behavior change. Then formulate strategies to meet each of those challenges.
• Improved time management and decision-making skills can be effective ways to overcome behavior change relapses.
• Offer participants with information regarding the behavior change process so that they will be better prepared for the challenges they will face. A brief overview of the Stages of Change may be helpful.

Most organizations do not have the Worksite Wellness Program resources to address all of their health needs at once. Priorities must be set to determine the most pressing health needs. Use the steps below to prioritize installation Wellness needs.

Assess the health needs of the population.

Collect data about the health needs in the community. How?

• Community- or target group-specific surveys

Identify health needs and at-risk populations.

Use the data to identify leading health needs and also high risk populations. By way of example:
• Obesity and overweight
• Injury prevention
• Self care

Reduce the list.

Not every health need can (or should) be addressed. Use the following questions to determine which health needs should be addressed first.
• How does the health need impact operational readiness? How big is the impact?
• What are the Upper Management priorities? How does the health need fit into those priorities?
• What are the behavioral factors affecting the health need? What is the evidence that a behavior change will make a difference? Has the behavior been successfully changed by other Worksite Wellness Programs?
• What other social, physical, or environmental factors influence the health need or the target population?
• Is the health need a greater problem at the local level than in the U.S. population as a whole?
• Does the organization have the subject matter expertise and resources to address the health need?

Develop Worksite Wellness Program recommendations.

Only a handful of specific health needs should be focused on in a given year. Keep the following in mind as recommendations are developed as to which specific health needs will be addressed:
• Avoid duplication of other ongoing Worksite Wellness Programs whenever possible. Identify Worksite Wellness Programs already addressing the health need and/or the target population.
• Identify and assess available resources. Build on existing services whenever possible.

Use the recommendations to offer tailored, targeted, integrated initiatives to address the prioritized list of health needs. Prioritizing health needs will keep Worksite Wellness Programs focused, maximize efficient use of resources, and align Wellness efforts with Upper Management goals and priorities.

References
• US Department of Health and Human Services, Planned Approach to Community Health, http://www.cdc.gov/nccdphp/publications/PATCH/index.htm.
• Implementing a Comprehensive Community Wellness and Well Being Program, presentation by CHPPM-EUR at the 2006 Force Health Protection Conference

Keeping the bottom line up front Bottom Line Up Front in Worksite Wellness Program will help you get and sustain Upper Management support. A Bottom Line Up Front approach will also help you more realistically measure the impact of your Worksite Wellness Program.

The bottom line in Worksite Wellness Programs answer two key questions:
• How will participant health be improved?
• What’s in it for Upper Management?

The ultimate bottom line: all roads should lead to readiness.
• Always be ready to communicate to leadership the ways that your Worksite Wellness Program impacts readiness.
• Think like Upper Management: what Worksite Wellness Program outcomes will be important from a Upper Management point of view?
• Develop line-centered language that communicates those outcomes.
• Ask participants how they think a particular Worksite Wellness Program enhances force readiness. This input is a valuable source of information.

Use the following steps as a Bottom Line Up Front approach to Worksite Wellness Programs.

Step 1: Think about the end of the Worksite Wellness Program first and plan backwards.

• It has been said, “If you don’t know where you’re going, any road will get you there.”
• Before planning or starting any part of the Worksite Wellness Program, be able to answer the questions: how will participant health be improved? What’s in it for Upper Management?

Step 2: Identify concrete Worksite Wellness Program outcomes.

• Identify up front what the Worksite Wellness Program is working towards.
o By way of example: will participants lose weight? Walk more steps? Decrease injuries? Move to another stage of change?
• Identify any processes or procedures that will be improved.
o By way of example: which pharmacy operations will become more efficient? How will record-keeping be streamlined?

Step 3: Determine what will be measured to show that Worksite Wellness Program goals were met.

• Consider what data is really needed to show Worksite Wellness Program effectiveness. Avoid the temptation to collect every possible piece of data. Choose a handful of important data points and stick to those.
• Think backwards when deciding what data to collect – consider how easily follow-up data can be collected when a Worksite Wellness Program ends. Getting follow-up data is often a challenge.
• Only collect data for health behaviors or indicators that the Worksite Wellness Program actually affected.
o By way of example: if the main Worksite Wellness Program goal is that participants will walk more steps, then it may be better NOT to choose changes in cholesterol level as a Worksite Wellness Program outcome (unless the Worksite Wellness Program specifically addresses cholesterol).
• Avoid measuring outcomes that the Worksite Wellness Program cannot (or did not) affect.

Step 4: Determine what Worksite Wellness Program elements must be included to move participants towards the Worksite Wellness Program goals.

• The concrete Worksite Wellness Program outcomes identified in Step 2 are the compass for keeping the Worksite Wellness Program on track. All Worksite Wellness Program elements should lead towards that ultimate goal.

Working backwards when planning and starting Worksite Wellness Programs is really forward thinking. Keeping the bottom line up front is a smart approach to Worksite Wellness Programs.

Health Information Technology can make the entire medical system more effective and efficient by enhancing:
• Documentation (lab and test results, clinic notes, consult recommendations)
• Communication (provider to patient, provider to provider)
• Information input (templates to facilitate data entry)
• Delivery of care (documenting all patient-provider interactions in a single system)
• Chronic disease risk identification (evaluation of risk factors, recommendations for appropriate preventive services and screenings)
• Consistent recording of correct billing codes

But, adapting to Health Information Technology is a challenge.
• Health Information Technology almost always involves a “new system.” Consequently, the entire staff, from medical providers to IM/IT personnel is on a learning curve.
• Existing IT infrastructure may not be adequate, so the Health Information Technology system may be very slow, or may frequently crash.
• The new system may not have all the forms you need already in place. New forms may be needed.

Lessons learned from Health Information Technology implementation

Take advantage of as many training opportunities as possible.
• Learn as much as you can about the Health Information Technology that you need to use. Become an expert.
• Ask questions if you are unsure how to navigate the system.

Keep the big picture in mind.
• Be aware that those keeping the Health Information Technology system up and running may have a very different set of priorities. The IM/IT staff may not see your request as a priority when it is taking all their manpower to trouble shoot the new system each day.
• Other changes to the Health Information Technology system may be in line in front of yours, so be patient.

Think through changes thoroughly.
• Take time to think through a new form thoroughly. Know exactly what you want before talking to the developer.
• Don’t think in a vacuum. If you build a form, make sure it is one your staff will use and find efficient.
• Make a draft version of the form and use it before requesting that it be put into the new system.
• Be prepared to build a good case for why your form should be created. Build a stronger case if your form should be developed ahead of other requests in the queue.
• Be patient and persistent when working with a programmer/developer on a new form. Meet frequently and set up timelines and deadlines.
• Coordinate with IM/IT and the Health Information Technology contractor to see if they can support a new project in the required time frame.

For more information about Health Information Technology implementation, go to the Agency for Healthcare Research and Quality (AHRQ) National Resource Center for Health Information Technology at http://healthit.ahrq.gov.

To effectively manage your Worksite Wellness Program resources, first determine the resources you need and the resources you have. Then develop a plan to fill the resource gaps.

What Worksite Wellness Program resources do you need?

• Make a list of workers, materials, equipment, space, and logistical support.
• Be as specific as possible.
• Include partnerships that will be needed to make the Worksite Wellness Program happen.

Identify available Worksite Wellness Program resources.

• Use materials that exist or are already on hand. Resist the temptation to start from scratch!
• Determine what other departments already have.
• Contact DHPW/HPPI to find out what other installations have done.
• Know where to borrow or get free materials.
• Use local or internal resources whenever possible.
• Look for opportunities to cut and/or share costs.

Develop a strategy to fill Worksite Wellness Program resource gaps.

• Partner with as many workers and organizations as you can. Emphasize what’s in it for them.
o Example: use a Physical Therapist to teach a back health class.
• Take advantage of community organizations and coalitions.
• Use volunteers as often as possible.
o Red Cross volunteers, medical interns or nursing students can supplement your manpower.

Former Worksite Wellness Program participants make good guest speakers.

• Keep a list of subject matter experts who will provide input for free so you can avoid the expense of an outside contractor or consultant.

Look for innovative Worksite Wellness Program opportunities.
• Other funding opportunities may exist at your facility.
o Example: if there is a book fair, see if you can apply to receive some of the proceeds.
• Ask the unit to contribute resources to Worksite Wellness Programs directly started at the unit level.
• Get to know the contracting person at your installation. They often know the least expensive places to obtain many different kinds of materials.
• Look for “recycling” possibilities.
o Example: IMD may be able to give you old computer workstations for use with electronic health assessments.

Good communication will help you find more partners and volunteers.

• Get the word out to the community about your Worksite Wellness Programs.
• Describe what you are doing and how you are doing it.
• Presentation is everything. Keep information current and use lots of visual aids.

All Worksite Wellness Programs require resources. Some resources you will already have. Some resources you will have to find. Sometimes you will have to make something out of very little. Smart strategies can maximize your Wellness resources.