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Introduction to Worksite Health Promotion Programs

The last ten years has brought big changes in company attitudes toward Worksite Wellness Programs. Interest in self-help and self-care programs has increased as growth in medical care expenditures have encroached substantially into profits. Changes in the company structures of medical care facilities, in particular the growth of the for-profit medical care sector, and the need to contain expenditures are changing the ways in which purchasers of medical care plans are viewing their own efforts toward provision of workplace medical care programs and facilities. Projections for the next decade indicate that workplace health programs will continue to become important factors in the provision of medical care, including prevention activities, for both government and private industry. In corporations with existing Worksite Wellness Programs, administrative rationale for sponsoring these activities ranged from improving employee health (28%) to improving employee morale (9.7%). Programs include interventions associated with safety, health risk assessment, smoking cessation, Blood Pressure control, nutrition programs and stress management. Benefits given range from improved health and work rate to lowering medical care expenditures.

Demographics of the U.S. Workforce
• 110 million American citizens were in the civilian labor force in 1981; by the year 2000 the civilian labor force is predicted to be nearly 140 million.
• 44% of the 1984 labor force was female; ten% was Black.
• The median age of the workforce is 32 years and is expected to rise to 32 years by 2030.
• 57.9% of all staff members work in employers with between 2 and 500 staff members; 45% work in employers with fewer than 100 staff members. An additional 7.5 million Americans are self-employed and 3 million are farmers.
• 18 percent of all wage and salaried staff members in 1985 were union participants.
• 45 percent of all employees are employed in offices.

Prevalence of Workplace Health Promotion Programs Activities

Based on a 1985 survey, almost 66% of worksites with 50 or more workers had Employee Health Promotion Programs activities in 1985.  The frequency of workplace-based activities by selected categories in 1985 was:

Activity

Smoking Control       35.6%
Health Risk Assessment    29.5 percent
Back Care             28.6 percent
Stress Management       26.6%
Exercise             22.1%
Off the Job Accidents    19.8%
Nutrition             16.8%
Blood Pressure Control    16.5%
Weight Control          14.7 percent

Worksite size is the strongest indicator of program prevalence.

Most staff members believe the advantages of their Corporate Wellness Programs activities outweigh the expenditures, even though few formal evaluations exist.

The most frequently cited reason for starting programs and perceived profit from programs is improved employee health.

At most worksites with activities (85.4%), all workers are eligible to participate. 30 percent of worksites with activities offer them to organization dependents, and an equal percent offer them to retirees.

When worksites seek outside program assistance, they turn to voluntary, not-for-profit companies (57.1%), private for-profit providers-consultants (50%), local hospitals (44%), and insurance companies (43%).

Smoking Cessation Programs

Smoking related health problems cost United States organizations $26 billion per year in lost productivity and $7 to $8 billion in tobacco-related health care costs.

Staff Members who use tobacco are 50 percent more likely to be hospitalized than people that do not use tobacco, have 2 times as many job-related accidents as people that do not use tobacco and have absenteeism rates approximately 50 percent higher than people that do not use tobacco.

People who used tobacco an average of one or more packs of cigarettes per day had 118 percent higher healthcare expenses than people that do not use tobacco.

76% of current smokers and 80% of former smokers and people that do not use tobacco feel that companies ought to restrict smoking to certain areas.

In 1985, 65 percent of smokers, 85 percent of people that do not use tobacco and 78 percent of former smokers, felt that tobacco users ought to refrain from smoking in the presence of people that do not use tobacco.

In 1986, 17 states had laws regulating smoking in offices or workplaces either in government-controlled offices or offices of private workers.

Examples of smoking cessation intervention program used by corporations include:

• offering people that do not use tobacco a discount of health and life insurance;
• paying full or partial fees for tobacco cessation programs;
• providing cessation programs on corporation or shared time;
• providing cash payments to quitters after 6 of 12 tobacco-free months;
• participating in national quit smoking days; and
• adopting a smoke-free company policy and setting deadlines for implementing the policy.

Physical Fitness Programs

An active 55-year-old man has the potential to lead as vigorous a lifestyle as a sedentary 35-year-old.

Differences in work-related activity has been established to give a two- to three-fold difference in cardiovascular deaths between active workers and their more sedentary counterparts.

In addition to improving strength, balance, and flexibility, exercise programs can cut the probability of back injuries among certain occupational groups.

93 million workdays in the United States are lost annually as the result of back concerns.

Research findings support the notion that worksite physical activity programs improve fitness and help decrease other health risks, although results related to improved productiveness are weak due to lack of methods for accurately quantifying productiveness.

A very small proportion of worksites have on-Site physical fitness facilities.

The majority of workers sponsored physical activity programs involve skills training such as aerobic dance, low impact aerobics, weight training, preand post-natal physical activity classes, and walking/jogging groups.

Some employers subsidize employee participation in community “Ys,” health clubs or other community programs if no on-Site facilities are available.

Job Site exercise program may decrease expenditures to employers by reducing employee health care claims and expenditures.

Those whose weekly exercise was equivalent to climbing less than five flights of stairs or walking less than a half mile, invested 114 percent more on health claims than those who ascended at least 15 flights of stairs or walked 1 1/2 miles weekly.

Health Care costs for obese people are roughly 11 percent higher than those for thin people.

Nutrition and Weight Control

One-third of this country population is obese to the extent of decreasing their life expectancy.

Improvements in eating habits can decrease the risk of serious health issues such as high Blood Pressure (BP) and blood lipid levels and is instrumental in the control of non-insulin-dependent diabetes.

The workplace offers several advantages for nutrition education; support and effect of co-employees and upper management, availability of a daily eating situation, and opportunities for follow-up and monitoring.

Worksite nutrition programs can be grouped in 6 broad categories:

• cafeteria programs;
• multi-component programs;
• weight control programs;
• cholesterol reduction programs;
• programs for pregnant and lactating women; and
• other diet education topics.

Men are less likely to participate in weight-loss programs than are female staff members.

Stress Management

Estimates suggest that 50% to 80% of physician visits are able to be attributed to psychosomatic or stress-related origins.

Employer pays many of the expenditures related to employee stress, both directly in the form of medical expenditures and in lower work rate.

Job factors which are associated with stress include:

• not allowing employees to take part in decisions about the work process;
• positions which require more or less skill than the employee has;
• changes in work demands;
• lack of clarity about expectations and standards; and
• conflict with co-employees or supervisors.

Most workplace stress management programs are implemented as a result of requests from workers.

Stress management programs focus on three types of skills: relaxation skills, coping skills, and interpersonal skills.

Job Site stress management programs are often delivered in one of three formats:

• courses conducted by trained professionals;
• self-learning tools; and
• personal teaching to assist  with self-assessment, planning for changes, learning new skills and responding to life crises.

The two primary techniques used in worksite stress management programs are:

• teaching people to decrease the negative physical effects of stress; and
• teaching people to recognize and control sources of stress at work and in personal life.

Safety Belt Usage

Motor vehicle accidents are the largest single cause of lost work time and on-the-job fatalities of American business.

Motor vehicle accidents account for 27 percent of all work-related deaths and 45 million days of lost work annually.

Greater than 36% of the 11,300 accidental work deaths in 1983 involved motor vehicles.

Staff Members who regularly fail to use seat belts may spend up to 54% more days in the hospital.

Traffic accidents caused about 3 times as many days of restricted exercise as any other type of disability.

Motor vehicle crashes cost $15.2 billion in lost productivity, 88 percent of which is attributed to losses from workforce activities and future earnings.

In work settings where safety belt policies, mandating use of belts by anyone riding in a company vehicle or using a private vehicle for company business, have been enforced, 60% to 90% use has been reported.

Incentive programs, accompanied by education and use requirement restrictions have resulted in 40% to 70% initial usage rates.

Factors influencing the sources of workplace safety belt programs include:

• active commitment on the part of upper management;
• clearly defined and well enforced policy of necessitated belt use working;
• beneficial incentives/rewards; and
• ongoing education and training programs.

Case Studies of Company Health Promotion Programs

Based on an extensive evaluation of its comprehensive employee Worksite Health Promotion Program, LIVE FOR LIFE, Johnson & Johnson reported the break-even point for the program occurs in year 3 and by year 5 they have a net profit of $316 per employee. Their year 9 projected profit is $677 per employee.

employees at four Johnson & Johnson businesses who were exposed to the Corporate Health Promotion Program increased their daily energy expenditure in vigorous exercise by 104 percent compared to a growth of 33 percent among employees at businesses that were provided only an annual health screen.

Members in the United Methodist Publishing House’s Company Health Promotion Program submitted more claims (1.14 per participating employee and .82 for the control in 1984, 1.44 and 1.3 respectively in 1985), but the average cost per claim was less for participants ($316 for participants and $567 for control, in 1984, $262 and $602 respectively in 1985, $270 and $566 respectively in the first four months of 1986).

The United Methodist Publishing House attributes some of the reduced than projected use in medical costs for 1985 ($902,116 projected with actual costs $142,884) to the Company Wellness Program although the results are not conclusive.

In 1985, the Adolph Coors Business conducted a telephone interview of a random sample of its 10,000 employees to determine changes in health practices since the introduction of an employee Company Health Promotion Program 4 years earlier. The sample of 495 employees was stratified to match the corporation profile in terms of age, sex and job description. The survey stated that 65% of respondents started working out in The previous 4 years, 37% had improved their diets, 20% were regular users of the wellness center, 9% had stopped smoking as the result of the corporation’s smoking cessation program and regular participants of the wellness center miss an average of 1.96 workdays each year due to illness or injury compared to 3.08 days for non-participating employees.

The Coors Organization also achieved a cost savings from a cardiac rehabilitation program that was implemented in 1981. In 1980 workers were out of work 7.2 months after a heart attack or bypass operation. In 1984, cardiac patients were out an average 1.9 months saving $152,000 in lost work time and in 1985 cardiac patients missed an average of 2.6 months, saving $125,000 that year.

Employer Exercise Programs Plans Improve Employee Health and Wellness

Instituting a Company Health Promotion Program improves the health of workers, decreases employee absenteeism and saves the corporation money, too. Learn more about starting an Company Health Promotion Program in the office.

Benefits of Company Wellness Programs

• A business investment of $100-$150 per employee each year to take part in an Workplace Health Promotion Program can save businesses $300 to $450 for each employee every year, according to Ron Goetzel, Director, Cornell University Institute for Health and Productivity Studies. The savings can take a few years to actualize, says Goetzel, and are seen in reduced health expenditures.
• The Wellness Councils of America reported a $24 return for every $1 invested on a Employee Health Promotion Program for small organizations.
• According to a 2005 survey by The Art of Health Promotion, companies who instituted Company Health Promotion Programs realized a 30% decline in medical and absenteeism expenditures in less than four years.

A efficacious Company Wellness Program begins with Senior Leadership. Employer owners ought to lead by example, taking part in their organization’s physical activity program and working closely with a wellness coach. Senior Leadership ought to make sure workers are well aware of their wellness efforts, displaying weight loss results or smoking cessation results on organization intranet or bulletin boards for everyone to see.

Worksite Wellness Programs that Truly Work

• Encourage employees to kick start their own wellness programs by visiting their doctor. A complete physical should include information about blood sugar, blood lipids levels and general health.
• Target specific health-related problems in a corporate exercise program. Information about how to fight obesity, smoking, alcoholism and prescription drug abuse must be at the forefront of an Company Wellness Program, along with related conditions.
• Hire a wellness coach to instruct employees on how to lead a healthy lifestyle.
• Reward employees for being active in corporation wellness plans. Let employees accrue wellbeing and health points that they can redeem for prizes. Make the prizes healthy, too- a free massage, personal training session with the corporation’s wellness coach or health food gift certificate encourages even healthier lifestyle choices.
• Acknowledge employee health and wellness leaders in employer newsletters, in posted bulletins and on the employer intranet.

Corporate Health Promotion Programs Provide Big Results

For business owners who want to broaden employee participation in a Employee Wellness Program, consider Johnson & Johnson’s approach. Faced with only 26 percent of staff members participating in their employee wellness and health program, Johnson & Johnson offered staff members a $500 discount on medical insurance costs if they completed a health risk profile. The number of staff members participating in the Johnson & Johnson business fitness program jumped after they provided the incentive — to more than 93%.

Ron Goetzel encourages those looking to pitch a corporate physical activity program to Senior Management to use basic facts about the advantages of Employee Wellness Programs as part of their argument. Keep it simple, and share results from other company’s employee wellness plan success stories.

Five reasons to have a wellness program

1.   The United States spends more dollars on health care than any other country yet we are not the world’s healthiest
   • Largely sedentary
   • Tobacco use is still popular
   • Stress is at epidemic levels (WHO)
   • Alcohol continues to take its toll on American citizens

2.   Much of the illness in The United States is preventable
   • Tobacco and alcohol are leading causes of death
   • As much as 70 percent of the cost of healthcare is driven by preventable illness

3.   Health Care expenditures continue to rise
   • Medical Care premiums continue to rise and to be passed on to the employee
   • Medical Care expenses are usually the number one benefit cost to most employers

4.   The worksite is an ideal setting to address health and well being
   • Most Americans work
   • Poor health habits take a toll on U.S. Businesses
   • Employers have a vested interest in health related concerns.

5.   Research validates that Employee Wellness Programs are able to better health, save money, and even produce a ROI.
   • Aldana,S.G. (1998). Financial impact of Employee Wellness Programs and methodological quality of the evidence. The Art of Health Promotion. Vol 2, Number 1.
   • Wilson, M.G. (1996). A accross the board review of the effects of Workplace Health Promotion Programs on health related outcomes: An update. The American Journal of health promotion. Vol 10, Number 6.
   • Wilson, M.G. (1996). A comprehensive review of the effects of Workplace Health Promotion Programs on health related outcomes: An update. The American Journal of health promotion. Vol 11, Number 2.
   • Chapman, L.S. Proof Positive: An analysis of the cost-effectiveness of worksite wellness. 3rd ed. Seattle: Summex Corporation, 1996.
   • Pelletier, K.R. A review of the health and cost-effective outcomes studies of accross the board health promotion and disease prevention programs at the workplace: 1993-1995 Update. The American Journal of Health and Promotion. Vol. 10, Number 5.

   
Key Components of a Worksite Health Promotion Program

Physical Wellness – Focuses on the development, maintenance, or improvement of one’s physical fitness

Sample Physical Workplace Health Promotion Programs / Workshops
• Annual health evaluation
• Regular physical exercise
• Good safety habits

Emotional Wellness – Focuses on all aspects of mental fitness

Sample Emotional Corporate Health Promotion Programs / Workshops
• Stress management workshops
• Accepting aging
• Addictive behaviors
• Parenting

Financial Wellness – Focuses on improving the quality of life of staff members by assisting families and individuals in becoming financially stable

Sample Financial Employee Health Promotion Programs / Workshops
• Financial management
• Savings and Investing
• Credit and Purchasing
• Insurance and Estate Planning

Spiritual Wellness – Focuses on promoting a healthy inner self

Sample Spiritual Company Health Promotion Programs / Workshops
• Encourage daily devotional readings
• Provide regular service opportunities
• Offer a daily/weekly/monthly chapel (meditation) time during work hours

Nutritional Wellness – Will see to the needs of the staff members through group and individual nutritional services

Sample Nutritional Employee Health Promotion Programs / Workshops
• Individual nutritional Assessment
• Individual and group counseling
• Educational classes
• Weight loss programs

Many employers, as part of their efforts to contain rising healthcare costs, are launching worksite programs variously described as Workplace Wellness Programs, lifestyle programs, health and productivity management, population health management and, simply, wellness programs.

The purpose of this article is to consider whether such programs better health. If so, do they in turn cut utilization of healthcare services and cut healthcare expenditures?

The popular media have done much to promote the concept of employer wellness. Last year, In Business: Madison magazine printed a story accompanied by a table reporting an impressive range of returns on investment (ROI):

Return on Investment (Per dollar ROI for lifestyle programs)
• Coors $6.15
• Kennecott $5.78
• Equitable Life $5.52
• Citibank $4.56
• General Mills $3.90
• Travelers $3.40
• Motorola $3.15
• PepsiCo $3.00
• Unum Life $1.81
Source: 2004 T.E. Brennan Company, as published

Would these ROIs stand up to thorough empirical analysis of the data? What factors produce such disparate returns among these programs? And does the published literature, subject to peer review of scientific methods, support the ROIs reported here?

Health and Productivity Leadership

Illness and injury associated with an unhealthy lifestyle or modifiable risk factors is reported to account for at least 25 percent of employee medical care expenditures. The most significant of these risk factors are stress, tobacco use, overweight or obesity, physical inactivity, excessive alcohol use, and poor nutritional habits. Over the past two decades, a variety of groups at the local, state, and national echelons have promoted the concept that health risk reduction and care management programs can better employee health, and that workplace health education, health risk management, and benefit counseling should complement standard health care insurance benefits.

The intensity of Company Wellness Programs range from bulletin board, pamphlet or newsletter information to onsite fitness facilities, health risk reduction classes, and personal lifestyle change coaching.3 Company Wellness Programs today often include a health risk assessment (HRA) to evaluate each employee’s potentially-modifiable risk factors of disease. Program coordinators then target interventions to those that are at increased risk through personal talks and individual follow-up.

Comprehensive Worksite Health Promotion Programs may include classes on health risk reduction and job safety, fitness and exercise activities, health club memberships, and reductions in co-payments or premiums for workers who adhere to recommended healthcare screening ground rules.

Along with this, some employers are restructuring health benefits and encouraging employees’ cost-sensitivity when accessing health care.5 These changes are intended to decrease employees’ need for and utilization of health care, yielding reduced group health care expenditures. Demonstrated reductions in health care expenditures should then support employers with a powerful bargaining chip in negotiating reduced health care insurance premiums during future terms.

Evidence basis: A range of return on investment estimates

The empirical research has produced results as varied as the popular media on ROI. Nonetheless, evidence continues to grow that well-designed and well-resourced Employee Wellness Program and disease prevention programs offer multi-faceted payback on expenditure. Peer-reviewed evaluations and meta analyses show that ROI is achieved through improved worker health, reduced benefit expense, and enhanced productiveness.

• Goetzel and colleagues, in their meta-analysis of two dozen articles summarizing economic evaluations of health and work rate management programs, found an average return of $3.14 per $1 invested in traditional Corporate Health Promotion Programs. The ROI estimates for the individual programs ranged from $1.49 to $13.7,8
• Aldana reviewed 72 articles and concluded that Company Wellness Programs achieve an average ROI of $3.48 when considering health care expenditures alone, $5.82 per $1 when examining absenteeism, and $4.30 when both outcomes are considered.
• Ozminkowski and collagues conducted a 38 month case study of 23,000 participants in Citibank, N.A.’s health management program and reported that within a 2 year period, Citibank realized a return on investment between $4.56 and $4.73.10  Follow-up studies saw improvements in the risk profiles of participants, with the elevated-risk group improving more than the “usual care” group11 as a result of more intensive programming.
• Chapman’s 2004 meta-assessment of 42 research studies, ranking overriding validity of the research studies, reports cost-benefit ratios from $2.05-$4.64.

In addition to immediately quantifiable expense reductions, researchers have reported a variety of spin-off benefits: greater productiveness, intellectual capacity, and reductions in disability12 and absenteeism.9,13,14,15 Such programs may also have positive effects on employee perceptions of the company14 and worker morale, even among nonparticipants. 13 These outcomes go beyond savings in direct healthcare expenditures to offer non-health related return on investment.

Tailoring program to maximize ROI Worksite Health Promotion Programs aim to cut the health risks of workers at elevated risk while maintaining the health status of those at low risk. A variety of disease management interventions are available to fit the specific risk profiles of various worksites. Insurers and companies now seek to calibrate their interventions in order to achieve optimal risk reduction and costeffectiveness.

In 2001, University of Michigan researchers published on stable trends in healthcare costs for over 2 million current and former workers in an 18 year data set. The mean cost increase per risk factor gained ($350) was found to be more than double the mean cost decrease per eliminated risk factor ($150). In other words, increases in costs when groups of workers moved from low risk to high risk were much greater than the decreases in costs when groups moved from high risk to low risk. Their conclusion: Programs designed to keep healthy people healthy will likely provide the greatest return on investment.

On the other hand, Pelletier’s meta-analysis16 and other program evaluations18 suggest that individualized risks reduction for high-risk workers within the context of inclusive programming is the essential element in achieving beneficial clinical and expense outcomes in worksite interventions.

Dose-Response?

Several factors might affect the impact of various programs and the ultimate ROI, including cultural and environmental factors, workforce demographics, level of participation and longevity of the program.

Most cost-benefit studies have been conducted in large companies with more than fifty staff members. But researchers have shown that similar results can be obtained by small companies with as few as five staff members actively involved in a well-managed program.

Various research studies also suggest that even relatively modest levels of participation have the potential to achieve substantial program effect. Contrary to reports by the popular media that such programs require more than 70 percent participation, published reports of at least one case showed beneficial ROI with 51 percent participation.

Length of intervention appears to be a more salient variable: an impact on medical expenditures generally requires three-to five years of programming.

Future developments

Despite the abundance of beneficial program evaluations, several caveats remain. Negative results are less likely to be reported or published, thus biasing the return on investment upward.

Uncertainty persists regarding the specific impact of the various program components. But as these programs take hold, further research and assessment will enable fine-tuning of program investments.

Meanwhile, the preponderance of data and the strength of the published research stand in favor of a positive return on investment for Workplace Health Promotion Programs. Indeed, the business case for such programs is now well enough defined that some insurance brokers offer discounted rates to employers that institute or subscribe to wellness programs.

Future questions will focus on how best to combine inclusive and focused interventions, the intensity of components, and how to calibrate the dose-response model to achieve a target return on investment. Here, employers, employees, and researchers will need to collaborate to define mutual goals/objectives in terms of both clinical and cost outcomes.

As organizations today continue to compete in the worldwide economy, expenditure containment strategies will be increasingly significant. Controlling the rising expenditure of employee sickness is becoming a priority for corporate leaders. The emerging corporate culture in this country is one which has an employee population centered in health, safety and wellness.

Creating a corporate plan for Company Health Promotion Programs and disability management makes good business sense. The following eight-step process ensures a strategic, integrated, needs-driven and outcome-oriented approach.

The following process works best in organizations with strong leadership and a long-term responsibility to employee health.

1. Identify Your Corporate Health Promotion Program Champion

This person should be a leader in your organization and a strong advocate of health. Typically this is an individual who actively pursues his or her own personal quest for ideal health.

The program champion must have the resources and authority to propel the program forward. The program champion’s key role is to make sure the strategic plan for health is in line with with the organization’s objectives, strategic focus and organization values. By way of example if the organization promotes that “our strength is our people” the wellness program must show how pushes will nurture and protect that significant resource.

2. Form Your Employee Wellness Program Strategy Team

The Workplace Health Promotion Program Strategy Team must include decision makers and stakeholders from parts of the company that are able to influence health and the company’s bottom line. These areas may include; finance, human resources, training and development, health services, compensation and benefits, employee assistance services (EAP), marketing, facilities, health and safety, rehabilitation, cafeteria or food services and the union. A team of six to eight representatives is recommended.

The role of the Strategy Team is to develop and enable the strategic plan, look for opportunities to encourage health, be sure the program is integrated into key areas of the organization, streamline efforts, maximize organization resources and program assessment.

3. Complete an Company Health Audit

The purpose of an Business Health Audit is to evaluate your existing programs and services, physical environment and policies & procedures that support health. It is also significant to look at your company culture or “how things are done” around the company.

Participants of the Strategy Team complete the Audit independently and then meet to discuss their assessment. During the assessment process, health problems and opportunities are discussed in preparation for the development of the strategic plan.

4. Analyze Your Organization’s Cost Pressures

Cost pressures are identified by analyzing a number of areas including; benefit expenditures, Workplace Safety Insurance Board (WSIB) claims, drug usage, type of paramedic claims, absenteeism data and EAP utilization. This process helps to target areas that are able to be positively impacted by a Employee Wellness Program and to offer a baseline for evaluating change.

5. Conduct a Health Risk Appraisal or Employee Needs & Interest Survey

The next step is to determine your employee’s health risks, interests and readiness to change. A confidential health risk appraisal can accomplish numerous goals and objectives. It supports a baseline from which to measure personal lifestyle changes, supports workers with relevant health information, motivates workers to take charge of their health and assists in program planning. Most health risk appraisals support individual reports and a corporate report identifying high-risk areas in the organization.

Many businesses prefer to administer customized needs and interest survey to evaluate employee needs. The benefit of this approach is that the business is able to gather information on the employees’ perceived wellness needs and program interests. This information can be incorporated into the strategic plan. Administering a survey also has the added benefit of fostering a sense of employee ownership to the program.

6. Develop Your Strategic Plan for Wellness

The strategic plan ought to incorporate information gathered from the Business Health Audit, your organization’s cost pressures, and health risk appraisal data or employee survey results. The strategic plan ought to include your program mission, three or four objectives and several initiatives under each intention. The strategic plan supplies a framework to encourage, backing and evaluate “best health practices.”

It is also valuable that the plan align itself with the vision, objectives and goals of the organization.

The sample strategic plan that follows was developed for blue jeans maker Levi Strauss & Co. (Canada) Inc. Levi Strauss & Co.’s mission statement and aspirations (how staff members interact with each other in a corporation environment) guided the development of the plan.

Levi Strauss & Co.’s aspirations include the following statement: Most importantly, we want satisfaction from accomplishments and friendships, balanced personal and professional lives, and to enjoy our endeavors. The wellness program plan included a number of components to make sure that it embraced this statement including the following:

1. A vision statement, which tied in with the company’s aspirations.
2. An incentive system to encourage and reward the accomplishment of healthy milestones.
3. A recognition system to applaud performance.
4. Friendly competitions between Levi Strauss & Co. locations to ensure an enjoyable environment.
5. Opportunities to participate in small group educational programs to foster team support.
6. Initiation of support groups for staff members completing wellness programs (i.e. smoking control support group).
7. Programs dealing with work and family balance.

Other information that was analyzed and used to develop the plan included:

1. Organization demographics
2. Focus groups
3. Cultural audit
4. Top prescription drug report
5. EAP utilization
6. Employee benefit services report
7. Health and dental claims
8. Operational success summaries
9. Health risk appraisals
7. Prepare a Organization Case to Support Your Plan

Your company case for wellness supplies the necessary details for approval at the upper management level. The company case includes:

1. The Strategic Plan for Health
2. A proposed program budget
3. Marketing strategies
4. Program leadership options
5. An implementation plan
6. Assessment methodology.

In presenting the strategic plan it is important to highlight how the plan aligns itself with the strategic direction of the organization.

The program budget must include educational resources, marketing costs, incentives, leadership costs and supplies.

Marketing strategies should address how the program will be promoted and rolled out to various groups within the organization i.e. decentralized locations, high risk employees, older employees.

Program leadership must address how volunteers will be used, internal resources  and whether consultants have been proposed. All play an equally significant role in the implementation of your wellness program.

The program implementation plan must incorporate the following types of programs that help foster awareness of positive health practices, assist  staff members in making lifestyle changes and pushes, which support long-term change.

Awareness programs foster an awareness of the effect of healthy lifestyle practices and innervate employees to take the next step. Examples of awareness programs include posting educational posters, newsletter articles and lunch and learn classes.

Lifestyle change programs are more accross the board and longer in duration. They are designed to support  workers in changing behavior. Examples of lifestyle change programs are nutrition education programs, stress management programs, back care classes and smoking control programs.

A supportive corporate environment encompasses everything from corporate policies & procedures, the physical environment and creating a corporate culture that supports great health practices. Follow-up sessions and support groups for staff members who have completed 6-10 week wellness programs also support a supportive environment for long-term change.

Evaluating the effectiveness of a Employee Wellness Program is ongoing. A formal assessment must be conducted each year and may include; re-administering steps three to five, program participation statistics and a year end survey to revisit “soft” problems such as morale, program satisfaction and future program direction.

8. Solicit Input and Communicate Your Plan

Employee input is critical to the long-term performance of your program. An Employee Advisory Committee ought to be formed to roll out the plan. Another key responsibility of this group is to solicit feedback from all levels of the organization to ensure buy-in. Front line Manager’s Information Sessions and focus groups are also important. This group needs to buy-in to the notion that they play a key role in supporting positive health practices. Regular gatherings are advised with front line managers to receive ongoing input, address problems and orient new managers.

Conclusions

The World Health Organization’s definition of health is “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.” In order for us to establish healthy workplaces, wellness drives must have a program champion, have employee ownership, be upper management supported, results driven and strategically aligned with the central employer objectives of the organization.

Wellness initiative that embrace these qualities will have a beneficial influence on an organization’s bottom line. Canadian research points to numerous case studies where onsite programs have resulted in decreased absenteeism, cut claims and increased productivity.

Corporations who have embraced wellness as part of “how they do business” share one thing in common. They show a commitment to their most important resource – their people. They know the increased pressures associated with downsized companies, a rapidly changing workplace, an aging work force and the challenge of balancing work and family obligations. And they share a common belief that healthy staff members are happier, absent less and more constructive.

References:
Design of Worksite Wellness Programs by Michael P. O’Donnell. 1995. Published by the American Journal of Health Promotion.
Pro Fit-ability by Veronica Marsden. Group Healthcare Management. May 1997.
Meeting Expectations by Laura Mensch. Employee Health and Productivity. August 1999
7 Steps to Health Promotion by Daphne Woolf and Veronica Marsden. Group Healthcare Management. February 1996.
Published in The Journal of Health Promotion for Northern Ireland, Issue 9, March 2000

Want some wellness program ideas and wellness policy ideas to get you started? Or perhaps you want to jump start or better upon your current wellness program? The list below provides ‘best practices’ that can help meet any wellness program budget! The Corporate Health Promotion Program ideas are divided into topic areas.

General Wellness Progam Ideas

• Conduct an Employee Needs & Interest Survey
• Organize a Worksite Wellness Program Committee
• Choose health insurance plans that cover expenditures for weight management and smoking cessation
• Waive co-pay or reimburse for preventive health care visits
• Put up handouts on a variety of wellness topics for employees to take
• Organize a wellness resource center or library with videos, books, magazines, DVD’s on a variety of topics of interest to employees
• Identify employees who are mentors or champions for healthy activities and ask them to present or to list as a contact for other employees
• Plan and encourage periodic or regular educational sessions.
• Develop monthly educational sessions on the national health observance topic
• Put up a Wellness Bulletin Board & update it monthly
• Put up messages from national health observances during the month
• Provide healthy tips in newsletters, paycheck stuffers, bulletin boards, etc.
• Offer a benefits fair
• Organize organization fitness and healthy eating challenges
• Develop corporation health and wellbeing fairs or other onsite activities

Nutrition Programs

• Offer free, healthy snacks for workers (fruit, nuts, popcorn)
• Provide healthy meal choices in cafeterias and at organization events
• Give information to employees about the nutritional content of food served in the cafeteria
• Organize a fresh fruit “snack basket” in the breakroom or cafeteria
• Stock snack machines with healthier options
• Partially fund healthy foods in the cafeteria or vending machines (10¡ apples may be more appealing than $1.00 candy bars)
• Begin a weekly or monthly healthy lunch club
• Give handouts available on a variety of healthy eating subject matters
• Include diet articles in organization newsletters
• Provide a healthy food tasting contest Free
• Have educational sessions at lunch-time on a variety of diet topics of interest
• Offer an employee healthy food cookbook. Either sell the cookbook and use profits for programs, or purchase a cookbook for all staff members

Weight Loss Programs / Weight Management Programs

• Provide flexible work schedules so that staff members can participate in weight-loss programs
• Partially fund registration expenditures for weight-management programs
• Provide a support group to help workers who are trying to lose weight
• Locate registered dieticians near your worksite as a resource for staff members who want information on healthy eating, meal planning or weight control
• Provide individual counseling for staff members trying to lose weight
• Offer workplace fitness and weight-management programs through your local hospital, Weight Watchers, TOPS or local, registered dietician
• Have an educational session on diet myths and healthy eating

Physical Activity Programs

• Offer flexible work schedules to encourage physical activity
• Design a fitness space with aerobic equipment, and weights
• Organize accessible walking paths, trails, and/or bike routes
• Urge workers to walk more by parking farther away from the entrance
• Create a gym with aerobic equipment, weights, aerobic classes, fitness professionals
• Hold walking meetings
• Make the stairways more appealing (carpet, fresh paint, artwork, posters)
• Offer reduced gym membership fees to all employees
• Offer facilities for staff members to secure bikes
• Provide 5 – ten minute stretch breaks during the day
• Partially fund fitness center membership for staff members who take part a minimal number of days per week (ex., 3 days per week)
• Support lunchtime walking/running clubs or organization sports team
• Urge stairwell use and incentives
• Install a basketball hoop outside
• Promote & support neighborhood walks or fitness activities
• Urge walking during breaks and other off-time periods
• Give periodic fitness incentive programs to encourage physical activity
• Provide educational sessions on fitness activities

Smoking Cessation Programs / Tobacco Cessation Programs

• Organize a tobacco-free grounds
• Create a tobacco-free workplace
• Encourage the use of 1-800-QUIT-NOW, North Carolina’s free Tobacco Use Quitline. Or check www.QuitlineNC.com
• Reimburse workers for tobacco replacement products
• Subsidize the expenditure of tobacco cessation seminars
• Give brochures and information on health effects from tobacco use and tobacco cessation
• Provide awareness sessions to innervate staff members to try to quit tobacco use
• Have onsite smoking cessation sessions

Employee Health Screening

• Discount health insurance premiums or decrease co-payments for employees who take part in screenings and who take part in managing their risk factors
• Install Blood Pressure monitoring equipment
• Provide flu shots for employees and family members
• Offer Health Risk Assessments to all employees, including counseling and follow-up
• Offer periodic Blood Pressure (BP) screenings and follow-up
• Offer periodic screenings for cholesterol, blood glucose, body composition, etc.

Stress Management Programs / Work Life Balance Programs

• Allow flexible schedules for family/work life balance
• Provide and promote an EAP
• Provide information on substance abuse prevention
• Give pamphlets and information on stress management and mental health
• Give brochures and information on work life balance, such as monetary planning, childcare, parenting, elder care, etc.
• Give supervisor and manager training on communication, relationship building, employer stressors, etc.
• Review business policies and work schedules to identify business stressors
• Evaluate the Employee Assistance Program(EAP) to ensure it is meeting the needs of the workers and employer
• Have educational sessions on stress management and work life balance
• Have courses on relaxation, stress management, and work life balance topics

Health screenings are significant programs to identify chronic disease in their early stages. Once identified, wellness behavior modification programs can help prevent a disease from progressing. Working with local hospitals and other companies, you can get information on offering assessment and behavior modification programs that might improve your employees’ health and save your employer money in absenteeism, treatment for disease complications, and reduced productivity. Below are some ideas to assist you in getting started.

Based upon your Employee Needs & Interest Survey and the demographics of your workplace, consider offering periodic screenings to find specific health risks such as:

• Blood Pressure Checks to identify employees with pre-hypertension or hypertension (high blood pressure),
• Cholesterol Screenings for total, HDL (good cholesterol), LDL (bad cholesterol) and/or Triglycerides
• Blood Sugar Screenings fasting or non-fasting to screen for possible diabetes,
• Body composition, such as body mass index (BMI) or body fat measures
• Bone density for potential risk of osteoporosis,
• Cancer screenings such as, skin examinations, mammograms, or PSA screenings,
• Vision checks for glaucoma, or visual acuity
• Other health screenings depending on your worker population and needs

Your local hospital, corporation physician practice, or health department may support assistance. Still, if you have employees you may want to concentrate on programs that will keep them healthy instead of screening for early identification of chronic disease. The focus of your wellness program might be healthy lifestyle practices to decrease risk and prevent disease.

In addition to the health screenings, consider offering a Health Risk Appraisal / Health Risk Assessment to all employees. The Health Risk Appraisal / Health Risk Assessment will help to identify factors that may lead to additional risks, such as smoking history, stress levels, perception of health, family history, job satisfaction, support systems, and mental health. Often the evaluation results are included on the Health Risk Appraisal / Health Risk Assessment, which provides a more inclusive snap shot of health risks. The summary results provide the significant information to plan appropriate interventions.

Worksite Wellness Program Interventions

The key to the performance of screenings and Health Risk Appraisals / Health Risk Assessments (HRA’s) is the interventions or follow-up programs. The data collected during the screenings increases awareness and often motivates employees to consider making healthier changes. It’s the follow up interventions that provide the critical backing and assistance required for employees to actually make and maintain those changes. The interventions can include individual follow-up and ongoing counseling, individual or group health coaching on the risk factors, behavior change programs, and/or company backing. Examples include:

• Strategies to lower Blood Pressure
• Managing diabetes
• Taking care of your heart
• Healthy eating
• Weight loss ideas
• Improving physical exercise
• Smoking Cessation

Naturally, this is for individual information only. Any follow-up interventions planned by the organization would be based on interest expressed by the employee.

Based on the outcome and your Corporate Wellness Program Committee goals and objectives you have the potential to plan the best strategies for your company and employees. Consider the community resources available to support services, such as health associations, hospitals, healthcare providers, and/or public health agencies.

Health Risk Appraisals / Health Risk Assessments, are an assessment tool or questionnaire scientifically designed to identify health risks and outline information to support  individuals in making healthy changes that influence their health and prevent chronic disease.

Health Risk Assessments / Health Risk Appraisals have four standard elements in worksite settings:
• A Questionnaire
• A Computer Program to Assess Health Risk Factors
• Confidential Individual Reports
• Group Summary Report

Workers complete a lifestyle questionnaire that includes for example diet practices, height and weight, exercise habits, family history, stress perceptions, smoking history, and work satisfaction. Another important feature to consider is readiness to change questions to determine participation interest. Including wellness screenings such as blood lipids and Blood Pressure (BP) results increases the benefits of an Health Risk Appraisal / Health Risk Assessment by offering a more accurate health assessment and therefore improving lifestyle choice decisions and program options. Nonetheless, it is important to determine if the Health Risk Appraisal / Health Risk Assessment can be used without including this information.

The health risk questionnaire information is entered into a computer program and an individual confidential report is generated that summarizes health risks as well as information on how to cut risk factors. Individual reports are totally confidential. Depending on the reason for launching the Health Risk Appraisal / Health Risk Assessment, it’s significant to consider the type of report the corporation will receive as well. A group report summarizing major risk factors and recommendations for programs to implement in order to cut employee and corporation risks provides significant information for your wellness program.

The Health Risk Appraisals / Health Risk Assessments (HRA’s) are able to be used to:
• Raise awareness to individual employee’s health status
• Motivate workers to make healthier lifestyle changes
• Coach high-risk employees
• Establish Company Health Promotion Programs based on the identified needs
• Review program effectiveness by comparing Health Risk Assessments / Health Risk Appraisals completed at set intervals such as yearly.

There are a myriad of benefits to thinking of a part-time or full-time occupational and environmental health nurse (OHN). Occupational health nursing is the specialty practice that supplies for and delivers health and safety programs and services to staff members, and worker populations. The practice focuses on promotion and restoration of health, prevention of illness and injury, treatment of work and non-work related injuries and illnesses, and protection from work related  and environmental hazards.

Onsite Heath Professional roles are able to include: Case management, Counseling, Worksite Wellness Program, Legal and regulatory compliance, Clinical services, and Hazard detection and controls. The American Association of Occupational and Environmental Health Nurses is the national association, www.AAOHN.org. The State Chapter also has a website with information including local chapter information to help you locate a contact near you, www.NCAOHN.org.

Health educators can design, conduct and evaluate activities that help better the health of all your workers. They are subject matter experts who may be a significant asset regardless your program needs and goals and objectives. They can help form a Employee Wellness Program Committee and implement a myriad of of its programs and services, for example or depending on the structure and time commitments of your Employee Wellness Program Committee, they can also coordinate the entire program as well. Integrating the activities of the Committee and/or Employee Wellness Program professional services within your operations, including within your safety and occupational health program will offer additional advantages!

We are organizing Workplace Health Promotion Programs to help you feel better and stay healthy. In order to plan programs that best meet your needs and interests we would like your ideas! Please take a few minutes to answer some questions about your interests. Your answers will be combined with those of others’ and reviewed to help plan programs for you. Do not sign your name.

Please complete the survey today and return it to__________. Thank you for your valuable input! Your help is valuable for organizing successful programs. Return the completed form by _____________.

Rate your interest on a scale of 1 – 3 with one (1) being of little or no interest; two (2) being of some interest and three (3) indicating that you are very interested. Indicate your response by circling or ‘Xing’ the number.

I am interested in:

Participating in wellness programs before work 1 2 3
Participating in wellness programs after work 1 2 3
Participating in wellness programs during my lunch break 1 2 3
Learning healthy eating options to lose weight 1 2 3
Sports nutrition 1 2 3
Healthier cooking 1 2 3
Helping my children eat healthier 1 2 3
Quick, healthy meals for busy lifestyles 1 2 3
Healthy snack options 1 2 3
Learning how to quit smoking 1 2 3
Attending classes to help me quit smoking cigarettes 1 2 3
Stress Mangement skills 1 2 3
Balancing work, family, and personal life 1 2 3
Time senior staff skills 1 2 3
Participating in a beginning physical activity program 1 2 3
Beginning time to exercise for busy people 1 2 3
Getting health information that I can read or watch at home 1 2 3
Learning about cancer prevention 1 2 3
Heart health options 1 2 3
CPR and First Aid 1 2 3
Team sports activities at work 1 2 3
Learning how to stretch 1 2 3
Learning how to stimulate intake of fruits and vegetables 1 2 3
Parenting Topics (age of children: ) 1 2 3
Onsite exercise classes: walking Yoga aerobic other: 1 2 3
Health evaluation such as Blood Pressure, blood lipids, blood sugar 1 2 3