Employer WellnessEmployer wellness programs and employer wellness consulting services

Evaluation of successful Employee Health Promotion Programs has revealed several primary Employer Wellness Program strategies to increase Employer Wellness Program effectiveness and impact overall Soldier health.

Strategy #5: Using a small number of targeted priorities maintains Employer Wellness Program focus.
• Needs assessment data can be used to identify leading health/wellness needs and also high risk populations.
• Choosing a handful of specific health/wellness needs on which to focus will maximize efficient use of resources.
• Keeping the Employer Wellness Program focus small will avoid duplication of other ongoing company Employee Health Promotion Programs.

Strategy #6: Use standardized processes whenever possible.
Reduce the amount of variation within your Employee Health Promotion Programs by standardizing all the processes needed for Employer Wellness Program planning and begination. 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 Employer Wellness Program 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 Employer Wellness Program resources in a variety of topic areas.

Strategy #7: Employer Wellness Program delivery methods should be flexible and adapted to population needs.
• Delivery of products and services may depend on: company 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 company’s may want services provided to them as close as possible to the company location; other companies may prefer as many services as possible bundled together at once (regardless of location).
• Take wellness and preventive medicine beyond the walls of the employer 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 Employee Health Promotion Programs has revealed several primary Employer Wellness Program strategies to increase Employer Wellness Program effectiveness and impact overall Soldier health.

Strategy #1: Communication with leadership is essential
• Assess leadership priorities.
• Report Employer Wellness Program outcomes back to leadership in a timely manner.

Strategy #2: Employer 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.
• Data should drive decisions regarding which health/wellness needs should be addressed first.

Strategy #3: Use electronic data collection and reporting as frequently as possible.
• Centrally collected data in an electronic format is essential for determining population health/wellness needs.
• Electronic reporting is also very valuable when communicating Employer 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 interventions.
• Don’t forget to look outside the employer for collaboration partners.
• Optimized Employer Wellness Program outcomes can be reached by coordinating the activities of medical experts, 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 Employer 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 members in successfully changing health behaviors.

Tool #1: Establish 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 activity and dietary 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 worthy 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 Employer Wellness Program members 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 members 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. Employees can move backwards or forwards or sometimes just stay put. Communicate to members that set-backs, lapses and even staying the same (i.e., maintenance) are common for individuals trying to change behavior.
• Stress is frequently a factor in lapses and relapses. Offer a variety of stress management resources to help members 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 members 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.

The majority of businesses do not have the Employer Wellness Program resources to address all of their health/wellness needs at once. Priorities must be set to determine the most pressing health/wellness needs. Use the steps below to prioritize company Wellness needs.

Assess the health/wellness needs of the population.

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

• Community- or target group-specific surveys

Identify health/wellness needs and at-risk populations.

Use the data to identify leading health/wellness 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/wellness 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 Employee Health Promotion Programs?
• What other physical, social, 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 employer have the subject matter expertise and resources to address the health need?

Develop Employer Wellness Program recommendations.

Only a handful of specific health/wellness needs should be focused on in a given year. Keep the following in mind as recommendations are developed as to which specific health/wellness needs will be addressed:
• Avoid duplication of other ongoing Employee Health Promotion Programs whenever possible. Identify Employee Health Promotion 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 interventions to address the prioritized list of health/wellness needs. Prioritizing health/wellness needs will keep Employee Health Promotion 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 Employer 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 Employee Health Promotion Program.

The bottom line in Employee Health Promotion Programs answer two primary 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 Employer Wellness Program impacts readiness.
• Think like Upper Management: what Employer Wellness Program outcomes will be important from a Upper Management point of view?
• Develop line-centered language that communicates those outcomes.
• Ask members how they think a particular Employer 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 Employee Health Promotion Programs.

Step 1: Think about the end of the Employer 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 Employee Health Promotion Program, be able to answer the questions: how will participant health be improved? What’s in it for Upper Management?

Step 2: Identify concrete Employer Wellness Program outcomes.
• Identify up front what the Employer Wellness Program is working towards.
o By way of example: will members 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 Employer Wellness Program goals were achieved.
• Consider what data is really needed to show Employer 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 determining what data to collect – consider how easily follow-up data can be collected when a Employer Wellness Program ends. Getting follow-up data is frequently a challenge.
• Only collect data for health behaviors or indicators that the Employer Wellness Program actually affected.
o By way of example: if the main Employer Wellness Program goal is that members will walk more steps, then it may be better NOT to choose changes in cholesterol level as a Employer Wellness Program outcome (unless the Employer Wellness Program specifically addresses cholesterol).
• Avoid measuring outcomes that the Employer Wellness Program cannot (or did not) affect.

Step 4: Determine what Employer Wellness Program elements must be included to move members towards the Employer Wellness Program goals.
• The concrete Employer Wellness Program outcomes identified in Step 2 are the compass for keeping the Employer Wellness Program on track. All Employer Wellness Program elements should lead towards that ultimate goal.

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

Health Information Technology can make the entire healthcare 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 healthcare 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.
• Create 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 needed 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 Employer Wellness Program resources, first determine the resources you need and the resources you have. Then develop a plan to fill the resource gaps.

What Employer Wellness Program resources do you need?

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

Identify available Employer 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.
• 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 Employer Wellness Program resource gaps.
• Partner with as many workers and businesses as you can. Stress 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 frequently as possible.
o Red Cross volunteers, medical interns or nursing students can supplement your manpower.

Former Employer Wellness Program members make good guest presenters.
• 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 Employer 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 Employee Health Promotion Programs directly started at the unit level.
• Get to know the contracting person at your company. They frequently know the least expensive places to obtain many different kinds of materials.
• Look for “recycling” possibilities.
o Example: You 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 Employee Health Promotion 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 Employee Health Promotion 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.

Organization processes are structured activities that achieve a specific result. By way of example, scheduling appointments is a employer process that results in an orderly work flow and timely patient care.

Employer Wellness Program implementation frequently requires changes to established employer processes. These changes may be simple, such as adding prescreening appointments to the scheduling process, or more complicated, like determining how time devoted to a particular Employer Wellness Program will be coded.

Not all change can be affected painlessly. However, developing a plan for achieving change will overcome barriers like:

“But we’ve always done it that way” or “But we’ve never done it that way.”

Each change situation will be different. The path to achieving change may not always be straightforward.

Lesson learned: Making small, incremental changes will be easier than trying to make one big change. It is also easier to modify a current process than to introduce a brand new one.

Develop a road map for change.

Describe the current employer process.
• By way of example: what is the current registration process for the weight management program? Include steps for both members and staff.

Identify where the new or modified employer process could fit into the current process.
• By way of example, prescreening appointments for the weight management program could be scheduled when members sign up OR the prescreening could be done at the first class.

Collaborate.
• Consider the change process to be a team effort. Determine everyone who will be affected by the change and get their input.
o By way of example, be sure to ask the personnel that set up the prescreening appointments AND the personnel that would do the prescreening for their ideas.
• Recruit one or more champions for the change. It helps if the champion has some clout.
• Get buy-in from as many workers as you can – including those that might be most resistant to the change.

Communicate.
• Don’t keep the change a secret. The more workers know, the more likely they will support a change.
• Anticipate barriers ahead of time. Be ready to articulate concrete benefits that will result from the change – especially advantages such as costs avoided or training time conserved.

Employer Wellness Program evaluation is critical for effective Wellness and will help you get Upper Management support.

Why evaluate your Employee Health Promotion Program?

Employer Wellness Program evaluation answers these questions:

• What change(s) occurred in the target population?
• ‘What’s in it’ for Upper Management?
• Are the resources that are being used worth the outcomes that are reached?
• Were Employer Wellness Program outcomes expected? (Unexpected outcomes may have occurred.)
• What Employer Wellness Program areas need improvement?

Employer Wellness Program Fact of Life:

Employer Wellness Program evaluation left to “chance” or until “there is time” will never happen.

• Employer Wellness Program evaluation should be considered as an essential part of the whole plan for Wellness and not as something extra.

Where do you start?

Keep it simple. Employer Wellness Program evaluation does not have to be complicated.
• Get baseline data.
• Baseline data is the health status of the target population at the beginning of the Employee Health Promotion Program.
• Start by collecting just 3 or 4 primary items as the baseline. You will have better success collecting follow-up information later if you only need to get a few pieces of data.
• Don’t rely only on health indicators that require lab evaluation. Also use self-report information and health indicators that are measurable without lab tests.

• Collect data that relates to readiness.
• You should always be ready to communicate to leadership the ways that your Employer Wellness Program impacts readiness. Plan ahead to collect data that will demonstrate this connection.
• Think like Upper Management: what Employer Wellness Program outcomes will be important from Upper Management point of view?

• It’s never too late to incorporate Employer Wellness Program evaluation into Employee Health Promotion Programs.
• If your Employer Wellness Program is already up and running and you didn’t plan for data collection ahead of time, start collecting data NOW.
• If you don’t have baseline data, then collect interim data and compare that to end-of-program data.
• Or, you can compare final Employer Wellness Program outcomes to similar initiatives elsewhere.

If you can’t make any comparisons to other data, use resources like The Community Guide (http://www.thecommunityguide.org/ ) that have already evaluated the effectiveness of Employer Wellness Program components. Compare the components of your Employer Wellness Program to those that have been proven effective elsewhere.

Think ahead: what unexpected challenges might come up as you begin your Employee Health Promotion Program? How could you adapt and change the Employer Wellness Program to meet those challenges?

• Consider the “what if’s?”

• What if your classroom space is suddenly no longer available?
• What if you can’t hold the Wellness Fair in the usual place?
• Have a ‘Plan B’ (or even Plan C or Plan D) in mind for when the “what if’s” happen.

• Build a team that can help with the Employer Wellness Program
• Who else could teach the health education class if the regular instructor cancels at the last minute?
• Know what areas of expertise your staff has besides their ‘main’ job. By way of example, find out who has excercise instructor credentials besides just the physical therapist.
• Don’t wait for a crisis before you build a network of workers that you can call on.

• Be ready to roll your sleeves up

• Jump in to fill a gap if you need to.
• YOU may have to help restock the milk case in the dining facility when the Dairy Month ‘Milk Mustache’ contest results in increased sales during lunch.

• Be willing (and ready) to respond to feedback about the Employer Wellness Program
• Get participant feedback while the Employer Wellness Program is ongoing. Then be ready to adapt to those suggestions.
• By way of example, if kids in a pediatric obesity Employer Wellness Program fight the idea of completing exercise logs, then get a verbal summary of their activity for the week instead.

• Simplify Employer Wellness Program
• If part of your Employer Wellness Program is not working, try making that part less complicated.
• By way of example, if getting follow-up information is not going the way you planned, then make the process to get information easier OR decrease the number of pieces of information that you collect.

• Use lemons to make lemonade
• What do you do when the Employer Wellness Program doesn’t turn out exactly as you planned? Look for what did turn out. Often, the ‘unexpected outcomes’ produce positive results.
• By way of example, one company’s database to collect sick call data was made obsolete by a regional system. However, the company database was able to be used in a different way to track vaccination information that improved delivery of care to Employees.