Worksite Wellness ProgramsWorksite Wellness Programs

Corporation America is increasingly investing in employee wellness because it is good business. In order to meet productivity demands, businesses must rely on a healthy, productive 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 Worksite Wellness , including reduced absenteeism, reduced injuries and workman’s compensation costs, reduced medical care costs, reduced employee turnover, as well as enhanced productivity, 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 profit realized. To enhance their performance federal government Worksite Wellness 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:

1. 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 activity, excess weight, unhealthy diet, elevated cholesterol, high Blood Pressure, stress, depression, and so on. High-risk workers are specifically targeted for intervention, even though the most efficacious 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. 2. Health risk appraisal

Use of a computerized health risk appraisal (HRA) instrument with individualized feedback and recommendations is almost universal in efficacious programs. Workers take the questionnaire each year in many cases. The HRA serves to increase awareness, support direction, and innervate individuals to improve specific behaviors. In some cases, the personalized 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. 3. Biometric Testing

Many programs combine the results 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. Computerized health risk appraisals often incorporate biometric data in their risk analysis.

4. 4. Incentives

workers are generally given monetary or other important 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 many cases the monetary incentives are associated with reductions in health insurance premiums. Some programs use disincentives as well as incentives, such as charging workers who smoke higher rates for their health insurance contribution.

5. 5. High participation rates

Successful 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 encourage participation.

6. 6. Wellness coaching

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

7. 7. Multiple formats

Programs may offer wellness content in online, paper, and seminar formats to support stimulating variety and alternatives in order to accommodate the needs of all workers. In addition to onsite physical activity and healthy eating events, on-line programs, e-mail reminders and notices, printed newsletters and materials, and company seminars are common dissemination strategies.

8. 8. Senior Management support

Enthusiastic and common endorsement by senior staff is vital to achieving high rates of participation. When senior executives are wellness role models themselves the effects of endorsement are enhanced.

9. 9. Frequent contact

Successful programs have common 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 wellness and health opportunities and reinforce the corporate emphasis on wellness through common and multiple “touches”.

10. 10. Open enrollment

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

11. 11. Family participation

Many programs encourage spouses and other family members to take part in the company 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. 12. Smoking cessation

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

13. 13. Exercise Programs

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

14. 14. Weight management

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

15. 15. Stress management

Workplace stress is perhaps the most common criticism among workers and a major contributor to absenteeism, presenteeism (reduced productivity), and low morale. Almost all efficacious wellness programs offer assistance with personal and workplace stress. Some programs refer workers to outside resources for more somber conditions like depression and anxiety disorders, but most offer online or common onsite general stress reduction programs. Some businesses endeavor to structure the work environment to minimize stress, both physically and operationally.

16. 16. Health screenings/immunizations

workers are actively encouraged to complete recommended medical care screenings for Blood Pressure, cholesterol, BMI, colorectal and breast cancer, and others. Annual influenza immunizations are also encouraged. Some sites support these services at the worksite. Incentives are often awarded for completion of these screenings/immunizations.

17. 17. Onsite medical care

Actual provision of onsite primary care medical services is a growing trend. The rapidly escalating costs of medical care insurance for workers has stimulated this trend. Some businesses have saw that it is less expensive to support primary care services themselves than to fund those services through health insurance. Onsite care also reduces the amount of time workers would otherwise spend away from the worksite getting such services.

References

1. 1. Aldana, Steven G. (2001) Financial Impact of Worksite Wellness : A Comprehensive Review of the Literature. Am J Health Promotion 15(5):296-320.
2. 2. Chapman, Larry. (1998) The Role of Incentives in Health Promotion. The Art of Health Promotion 2(3):1-8.
3. 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. 4. Chapman, Larry. (2005) Meta-Assessment of Worksite Wellness Economic Return Studies: 2005 Update. The Art of Health Promotion, July/August, 1-15.
5. 5. Chapman, Larry. (2006) Employee Participation in Worksite Wellness and Worksite Wellness : How Important are Incentives, and Which Ones work Best? North Carolina Medical Journal 67(6): 431-432.
6. 6. Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth. (2007) The Role of Health and Wellness Coaching in Worksite Wellness . The Art of Health Promotion, July/August, 1-12.
7. 7. Chapman, Larry. (2007) Proof Positive: An Analysis of the cost-Effectiveness of Worksite Wellness. Northwest Health Management Publishing, Seattle, WA.
8. 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. 9. Edington, Dee. (2001) Emerging Research: A View from One Research Center. American Journal of Health Promotion 15(5): 341-349.
10. 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. 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. 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. 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. 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 Worksite Wellness Program. They help you discover if your objectives were met. It is a good idea to add an evaluation component to your Worksite Wellness Program. Evaluations may conclude that some interventions didn’t work well. You may learn 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 develop 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 and objectives. Three major areas of an evaluation

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

Common questions used to evaluate a Worksite Wellness Program

Worksite Wellness Program Structure Questions

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

Worksite Wellness Program Process Questions

• How many people take part?
• Do participants complete the Worksite Wellness Program?
• Are participants satisfied?
• Which aspects of the Worksite Wellness Program are best attended?

Worksite Wellness Program Outcome Questions

• Does the Worksite Wellness Program improve knowledge about health concerns?
• Does the Worksite Wellness Program change behavior?
• Does the Worksite Wellness Program save the company money?
• What is the return on investment (ROI)?
• Identify through an employee survey what incentives they value.
• Identify what incentives the company can support as well as what the budget will allow.
• Make sure that every colleague who achieves a objective receives some recognition.
• Avoid offering incentives for the “best” or the “most.”
• Avoid using food as a reward.
• Use incentives to reward your Worksite Wellness Program, through logos and branding.

Incentives encourage workers to adopt positive behaviors or maintain an existing positive behavior that may potentially help the employee stay healthy and live longer. Adopting positive health behavior is fundamentally what wellness is about. Incentives can be used to increase participation rates, help individuals complete a Worksite Wellness Program, or help individuals change or adhere to healthy behaviors. Providing incentives and rewards will send an important message to the workers that your company is committed to helping them with bettering their health. It also plays a important role in motivating individuals to take part. Tips on how to choose appropriate incentives:

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

When starting a comprehensive Worksite Wellness Program, make sure that it consists of a variety of awareness, lifestyle modification, 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 beginning a Worksite Wellness Program:

• Develop activities based on your intended goals and objectives addressing the specific needs of your workers. Focus on those subject matters that are of greatest interest to your workers and the greatest needs of your company, in that order. Avoid subject matters with narrow appeal.
• Keep it simple. Design the Worksite Wellness Program so it’s easy for the participants to understand and track.
• Integrate a combination of activities to include awareness, educational, and behavior elements.
• Choose activities in which every employee can take part.

Recommendations for your Worksite Wellness Program:

• Challenges. Activities that focus on practicing a desired behavior that continues for 4-8 weeks and focuses on specific subject matters (such as physical activity, nutrition, or stress management).
• Learning experiences. This includes seminars, videos, and classes.
• Behavior changes (such as smoking cessation). You may or may not offer interventions at the workplace. Nevertheless, you ought to encourage individuals 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, elevated 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 Worksite Wellness Toolkit.

Successful wellness programs are designed to meet the needs and interests of the workers. Ask workers what they are interested in, and what needs they have. People are more willing to take part and support wellness efforts if they are involved in the decision-making process. When starting a survey, keep the following hints in mind:

• Ask mostly closed form questions, especially if you will be sending the survey to a sizable number of workers. Closed form questions support specific choices and are easy to tabulate.
• Invite comments, ideas 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 company 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 might increase 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 important. 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% to 50% is considered important.

A vital first step in organizing your company’s wellness program is the formation of a Worksite Wellness Program Committee. The focus of the Worksite Wellness Program Committee is to plan, reward, and enable the program. The Worksite Wellness Program Committee establishes continuity, motivation, and broad ownership of the program as well as supports 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 Management within your company
• Union representatives
• Human resources department
• EAP
• Information technology
• Communications
• Health and safety department
• workers interested in wellness and health

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 starting a Worksite Wellness Program. Anywhere from 4 to 10 people meeting monthly equals a Worksite Wellness Program Committee. A mission statement for the Worksite Wellness Program Committee ought to be developed by the second meeting. This way, everyone knows what the Worksite 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 critical to building a efficacious wellness program! Visible senior staff support is one of the most vital factors in the success of a worksite Worksite Wellness Program. Senior Staff executives are responsible for making sure that the company meets its objectives. They can support additional assistance by helping you to link your Worksite Wellness Program objectives to company outcomes, thereby positioning Worksite Wellness Program as a fundamental part of the company. It is important to create support and excitement for the program from all echelons of the company including upper management, mid-level management, and grass-root workers. The challenge for any Worksite Wellness Program coordinator is convincing senior staff about the potential value of Worksite Wellness Program to the company and conceptualizing how Worksite Wellness Program initiatives can influence the company 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 Worksite Wellness Program. Worksite Wellness Program support 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 events
• Leadership by management, such as the distribution of a letter of support for the program.
• Flexibility of employee schedules to accommodate wellness activities

The first step in starting your wellness/Worksite Wellness Program is to understand your company and how Worksite Wellness 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 company.

Worksite Wellness Program: Research Questions

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

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

The costs of medical care have been rising more than 10 percent each year for several years. A substantial amount of the money spent in the medical 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 medical 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, lower avoidable medical care utilization and enhance work execution, and in turn reduced medical care costs and improve employee satisfaction and retention, many businesses are starting, or are interested in starting, Worksite Wellness for workers.

The benefits of worksite wellness are well documented. More 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 medical care costs per dollar invested.
• Savings of $5.82 in lower absenteeism costs per dollar invested.
• ROIs of at least $3 to $8 per dollar invested within five years of program implementation.
• Lifestyle behavior change programs: $3 to $6 ROI within 2 to 5 years.
• Self care, decision support programs: $2 to $3 ROI within a year.
• Disease management programs: $7 to $10 ROI within a year.

By offering health improvement programs, businesses are not only offering an additional service for workers, but they are also gaining financially. Furthermore, the influence of a health improvement program goes beyond lowered medical care cost and ROI. A health improvement program can affect productivity, absenteeism, morale, recruitment success, turnover, and medical care costs. Source: Rees, C., and Finch, R. (2004). Health Improvement: A comprehensive guide to beginning, implementing and evaluating worksite programs. National Business Group on Health, 1 (1), 1-7.

According to the American Journal of Health Promotion, “Health promotion is the science and art of helping people change their lifestyle to move toward a state of optimal health. Optimal health is defined as a balance of physical, emotional, social, spiritual, and intellectual health. Lifestyle modification can be facilitated through a combination of efforts to enhance awareness, change behavior, and establish environments that support good health practices. Of the three, supportive environments will probably have the greatest influence in producing lasting change.”

Worksite Wellness Program: Action Steps

The process of building a Worksite Wellness Program involves:

• Identifying the current health status of your workers
• Determining the appropriate programs and interventions to offer
• Promoting and implementing the programs
• Building in motivational incentives
• Measuring the influence
• Revising programs based on evaluation outcomes

It may even include starting policies and procedures that support employee participation in wellness activities at your worksite (such as flextime).

Steps to Starting a Worksite Wellness Program

• Conduct an company assessment
• Obtain senior staff support
• Establish a Worksite Wellness Program Committee
• Obtain employee input
• Develop goals and objectives
• Design and enable program activities
• Choose incentives
• Review outcomes

One of the ways the government plans to improve the nation’s health is through comprehensive Worksite Wellness . According to the United States Department of Health and Human Services, these programs may help workers live healthier lifestyles by creating supportive work environments and offering awareness, education and behavior change programs. In fact, one of the goals and objectives of Healthy People 2010, a set of health objectives for the nation to achieve by the year 2010, is to increase the proportion of workers that take part in a comprehensive Worksite Wellness Program at their worksite to 75 percent.