Worksite Wellness ProgramsWorksite Wellness Programs

Incentives can be used to increase participation rates, help with completion or attendance at programs, and to help individuals shift or adhere to healthy behaviors. The purpose of the incentive is to encourage workers to adopt positive behaviors or maintain an existing positive behavior. Everyone who achieves a objective or maintains a behavior ought to receive something. Many businesses also support incentives merely for participating in events. Stay away from being the “best” or doing the “most.” Encouraging workers to be the best or doing the most promotes excessive behavior, discourages others, and creates elitism. The best designed incentive programs are ones which are based on achieving goals and objectives that are attainable by most individuals. Recognition, acknowledgment by top management, or special privileges are examples of great intangible incentives. Incentive ideas:

• Free or Low-Cost
• Certificates
• Movie passes
• Recognition in employee newsletter
• Mugs
• Water bottles
• Commendation from management
• T-shirts
• Hats
• Moderate Cost
• Entertainment tickets
• Sweatshirts
• Waist packs
• Subscriptions to health magazines
• Health and fitness books
• Videos
• High Cost
• Week-end getaways
• Dinner for two
• Clocks
• Watches
• Others
• Cash
• Gift certificates

A major issue in wellness programming is attracting workers to take part and maximizing participation. When introducing a program, a letter briefly explaining the program signed by the president or CEO is a great endorsement. Utilizing posters, newsletter articles, and brochures are good means of promoting the program. Other promotional methods to consider are e-mail and announcements at employee meetings. Ask Worksite Wellness Program Committee members to recruit participants. Once the program is kicked off you may want to support an incentive for any employee who recruits another employee to any of the program offerings.

When selecting a program from a vendor you ought to ask the following questions:

• How many worksites have done the program?
• What types of employee population was the program provided?
• What educational materials are used?
• Will the program meet the needs of workers?
• What are the techniques used to help change behaviors?
• Does the program help workers move through stages of readiness to make health behavior changes?
• How do you market the program to workers?
• What follow-up do you support?
• How do you make referrals for medical care or other supportive services workers may need?
• How do you know the program works?
• How do you measure colleague satisfaction?

When staffing your wellness program you need to consider whether to hire a wellness employee or contract with wellness professionals from outside your company. Small and medium size worksites do not usually have a wellness professional on employee. If your worksite is in this category, you will need to contract with providers outside your company. Large businesses have several options. They can hire a employee solely for the wellness program, they can contract with outside wellness providers, or they can use a combination of internal employee and outside providers. When selecting a provider some key questions in the areas of employee, program structure, process, and performance need to be addressed. Each of these key questions is discussed in the following sections.

Staff

Health professionals become wellness professionals when they are trained in the full range of wellness activities. Wellness professionals are generalists who come from a wide variety of backgrounds and schooling. They may be nurses, dietitians, health educators, counselors, exercise physiologists, or have other backgrounds. But in addition to their primary training, they know something about all wellness subject matters, including smoking, stress, exercise, and nutrition. They also know how to engage and support people in making and sustaining health improvements and have good people skills. Generally, wellness professionals at worksites fall into three broad categories, wellness screeners, wellness counselors, and wellness instructors.

• Wellness screeners introduce workers to the program, take health measurements, collect health-related information, support initial counseling, and help workers define for themselves what they need and want in a wellness program.
• Wellness counselors work with workers after the evaluation to help them establish and carry out a plan to lower their risks and improve their health.
• Wellness instructors teach classes and minigroups on different health subject matters.

A wellness program in a small company can be staffed by a single employee person who fills all three roles. Larger worksites will use different workers to fill these roles. When choosing employee or choosing among vendors, ask the following questions:

• Do prospective workers have a range of health backgrounds that will support appropriate expertise in the subject matters to be addressed?
• Have prospective workers functioned well as wellness screeners, wellness counselors, and/or wellness instructors?
• Will this employee include workers from the racial and ethnic backgrounds found in your employee population?
• Is each employee member comfortable with the range of backgrounds found in your employee population, and able to communicate effectively with the various social and educational levels of your workers?
• Do workers have a warm, but professional, counseling style when interacting with workers?

An yearly plan for the major wellness programs and activities is a useful management tool. This is an great Worksite Wellness Program Committee task. Often an activity and wellness theme per month is provided to workers. Some businesses choose to follow a National Health Observances calendar which offers advantages. The materials developed by these various national health businesses are very credible. The materials are usually high quality and available free or at a nominal expense. The company benefits from additional publicity that occurs in various media throughout the community related to the national observance. For planning recommendations you may want to utilize the HOPE Publications Wellness Resource Planning Guide available for free at this Web site.

A Health Risk Appraisal (HRA) is occasionally used in conjunction with a health evaluation. An HRA is a computerized assessment tool which looks at an individual’s family history, health status, and lifestyle. An HRA seeks to identify precursors associated with premature death or serious illness and quantifies the probable impact for each individual. An HRA instrument is derived from an understanding of the course of a disease. Based on this understanding, useful prediction instruments can be constructed to evaluate the health risks of an individual. Individuals with a higher number of health risks tend to have more somber health concerns over time. Drawing attention to their health risks can help clients lower risk factors which lead to the onset of unnecessary disease and subsequent premature death. The questionnaire covers lifestyle habits (such as smoking, Seat Belt use, and exercise) and physical measures (such as cholesterol, Blood Pressure levels, height, and weight). For accuracy, it is crucial to get direct measures of Blood Pressure, cholesterol and HDL-cholesterol. The HRA also supports recommendations and indicates what risks are modifiable. Types of measures to evaluate health risks are discussed under Screening Programs. The influence of a health risk appraisal is much greater when it is given in-person, with immediate feedback to the client. This also supports an opportunity to invite the client’s participation in continuing health counseling and to gain their written consent to do pro-active outreach to them. A health age can be computed based on the individual answers to the questionnaire and physiologic factors. The health age may indicate the individual to be younger or older than their chronological age. HRA programs are one the most prolific types of wellness activities utilized by businesses. Continuing research on HRAs is examining the efficacy of this tool. One of the big benefits of this tool is that it can support an aggregate group report of a company and can be utilized as an evaluation tool. Detailed information is available from the Society of Prospective Medicine (www.spm.org/desc.html) who publishes a handbook on HRAs.

The most common evaluation performed in Worksite Wellness is heart health assessment. The evaluation 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 conducting the evaluation then supports a consultation and helps set goals and objectives with the colleague.

The backbone of wellness programming at the worksite is health evaluation. It is the first major activity a company ought to do when first starting a wellness program. Health evaluation 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 evaluation techniques and counseling to privately and individually evaluate 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 provided. 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 supports an immediate opportunity to register participants in various health improvement programs based on their interests and identified health risks. Health evaluation can be done on an yearly basis and used as a means of monitoring health risks within the worksite. A health evaluation program needs to support multiple opportunities for participation. The service ought to be provided for all the various shifts of a company. The evaluation program ought to be conducted in highly visible areas so the process can be observed. Reluctant workers often like to be able to see what the program is about before they take part. When wellness screeners are not busy, they ought to perform outreach going to areas where workers gather and attempt to recruit workers. When well-planned and promoted, health evaluation can attract participation rates of 60% to 100%. These high participation rates have a positive influence on management producing support 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 company. Goals like mission statements support 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:

• Number of participants screened
• Number of participants in and completing health improvement programs
• Satisfaction of program participants
• Number of participants who were medically referred and saw their physician
• Number of promotional activities
• Number of participants seen in follow-up

Example of outcome objectives are:

• Number of participants who improved fitness level
• Number of participants who lowered cholesterol level
• Number of participants who lost weight, body fat
• Number of participants who quit smoking
• Number of participants with elevated Blood Pressure who lowered their Blood Pressure
• Number of participants whose initial level of alcohol consumption put them at-risk who are no longer at-risk
• Number of participants with risk factors who saw their physician and are being treated for elevated Blood Pressure or cholesterol years later

Wellness committees are important in that they create a sense of ownership in the program, and facilitate various tasks involved in wellness programming at the workplace. The Worksite Wellness Program Committee ought to be composed of a cross-section of workers representing various occupations, levels, and subgroups with the company. A common mistake is filling the Worksite Wellness Program Committee with the most health/fitness-conscious people in the company. Don’t rely solely on volunteers to fill a Worksite Wellness Program Committee. Make sure that your Worksite Wellness Program Committee members have sufficient power in the company to run an effective wellness program. The Worksite Wellness Program Committee is made up of workers from the workplace. It oversees the wellness program and helps carry it out. The Worksite Wellness Program 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 Worksite Wellness Program Committee may meet on a weekly basis until things get going. Committee members do not carry out medical care procedures, counsel clients, or handle confidential health information. Wellness professionals perform these tasks. In general, the Worksite Wellness Program Committee’s duties fall into three areas: planning, promoting, and helping to run programs. Planning the programs can include:

• Finding space for activities
• Planning and organizing worksite-wide events such as contests
• Reviewing reports prepared by the program employee and making recommendations

Promoting the program can include:

• Recruiting workers to take part in evaluation and health improvement programs
• Encouraging workers to take part in follow-up counseling
• Organizing promotional strategies using newsletters, signs, bulletin boards, computers, and other media available within the workplace

Helping to run the program can include:

• Setting up equipment for various activities
• Helping to conduct worksite-wide activities
• Monitoring all activities and reviewing the performance of the professional employee
• Acting as wellness mentors to fellow workers

The size of the Worksite Wellness Program Committee will be dependent on the size of the company. Pick members by asking day management to nominate or appoint workers. Make an announcement through brochures, memos, and meetings to recruit potential members. Explain the purpose of the Worksite Wellness Program Committee, duties and responsibilities, and the time commitment. Recognize your Worksite Wellness Program Committee volunteers. Allow them to take part in programs at a reduced expense. Have appreciation breakfasts/lunches/dinners. Print names of Worksite Wellness Program Committee members on company 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. Develop awards certificates for members. The following can be used as a guide for Worksite Wellness Program Committee size:

• Less than 300 workers 2 to 4
• 300 to 1,000 workers 4 to 6
• 1,000 workers or more 6 to 12