Company Health and Wellness : Workplace Health Promotion Programs: Effective Components

Organization America is increasingly investing in employee wellness because it is good business.  In order to meet productivity demands, companies must rely on a healthy, advantageous 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 Company Wellness Programs, including reduced absenteeism, reduced injuries and workman’s compensation expenditures, reduced healthcare expenditures, reduced employee turnover, as well as increased productivity, greater worker satisfaction, and improved morale.1-10  

The more recent literature reflects improvements in wellness programming along with greater return on investment (ROI).  In general, the more focused and intensive the program, the greater advance realized.  To enhance their effectiveness federal government Employee Wellness Programs may be able to incorporate some of the features described.  Employee wellness programs established to have beneficial returns on investment frequently include the following features:

1.   Health and work rate management model
Programs characterized by this model focus attention on identification and reduction of specific risks or behaviors such as smoking, lack of physical exercise, excess weight, unhealthy diet, elevated cholesterol, high Blood Pressure (BP), stress, depression, and so on.  High-risk staff members are specifically targeted for intervention, although the most thriving programs also direct efforts towards healthy staff members in order to maintain their low-risk status.  This model emphasizes outcomes as opposed to simply offering wellness activities for their own sake.  

2.   Health risk appraisal
Use of a computerized health risk appraisal (HRA) instrument with individualized feedback and recommendations is almost universal in thriving programs.  Staff Members take the questionnaire annually in many cases.  The HRA serves to expand awareness, provide direction, and innervate people to better specific behaviors.  In some cases, the customized 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.   Health Screening
Many programs combine the outcome 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.   Computer health risk appraisals often incorporate biometric data in their risk analysis.

4.   Incentives
staff members are frequently given monetary or other valuable rewards for completing an HRA, participation in a program or class, specific accomplishments such as stopping smoking, losing weight, or working out, and for maintaining healthy status and/or behaviors.  In many cases the monetary incentives are associated with reductions in medical insurance premiums.  Some programs use disincentives as well as incentives, such as charging staff members who smoke higher rates for their medical insurance contribution.

5.   High participation rates
Effective programs use rewards and incentives to drive participation rates up.  They also market their programs extensively, and may use contest or challenge strategies to heighten enthusiasm and bolster participation.

6.   Wellness coaching
employees with identified risks or desire to improve their health habits may be periodically coached via phone by trained health and wellness coaches.  Health and Wellness Coaching helps employees set and achieve realistic lifestyle-related objectives including those discussing 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 employees with identified high-risk diseases.

7.   Multiple formats
Programs may offer wellness content in online, paper, and seminar formats to offer stimulating variety and alternatives in order to accommodate the needs of all staff members.  In addition to on-Site physical exercise and healthy eating programs, on-line programs, e-mail reminders and notices, printed newsletters and materials, and employer courses are common dissemination strategies.

8.   Senior Leadership support
Enthusiastic and common endorsement by management is essential to achieving high rates of participation.  When senior executives are wellness role models themselves the effects of endorsement are enhanced.

9.   Frequent contact
Effective 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 health & wellness opportunities and reinforce the corporate emphasis on wellness through common and multiple “touches”.

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 employers automatically enroll all workers and then allow those who do not wish to take part to “opt-out”.  This practice has been determined to boost enrollment rates in some settings.

11.   Family participation
Many programs encourage spouses and other family members to participate 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.   Smoking cessation
Because smoking and other tobacco use is the number one threat to health it is essential to offer workers effective and convenient assistance with quitting.  Access to tobacco cessation pharmaceuticals is frequently part of such programs.  In-house programs support the most convenient access to these services, although on-line or phone-based programs may be available as well.  

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

14.   Weight management
Because obesity is a primary threat to health it is imperative that programs offer effective assistance with weight control.  Enthusiastic encouragement from management to shed excess weight is important.  Internet based programs, workplace programs, or discounted access to weight control programs in the community may all be available.  Long-term follow-up is essential for maintenance of weight loss.

15.   Stress management
Workplace stress is perhaps the most common concern among employees and a major contributor to absenteeism, presenteeism (reduced work rate), and low morale.  Almost all successful wellness programs offer assistance with personal and worksite stress.  Some programs refer employees to outside resources for more somber conditions like depression and anxiety disorders, but most offer web-based or persistent worksite general stress reduction programs.  Some employers endeavor to structure the work environment to minimize stress, both physically and operationally.

16.   Wellness screenings/immunizations
staff members are actively encouraged to complete recommended health care screenings for Blood Pressure, cholesterol, BMI, colorectal and breast cancer, and others.  Annual influenza immunizations are also encouraged.  Some sites offer these services at the workplace.  Incentives are frequently awarded for completion of these screenings/immunizations.

17.   Onsite healthcare
Actual provision of on-Site primary care medical services is a growing trend.  The rapidly escalating expenditures of medical care insurance for employees has stimulated this trend.  Some employers have found that it is less expensive to offer primary care services themselves than to fund those services through health care insurance.  Onsite care also reduces the amount of time employees would otherwise spend away from the workplace getting such services.

References

1.   Aldana, Steven G.  (2001)   Financial Impact of Company Wellness Programs:  A Comprehensive Review of the Literature.   Am J Health Promotion 15(5):296-320.
2.   Chapman, Larry.  (1998)   The Role of Incentives in Health Promotion.  The Art of Health Promotion  2(3):1-8.
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.   Chapman, Larry.  (2005)   Meta-Evaluation of Employee Health Promotion Programs Economic Return Studies: 2005 Update.  The Art of Health Promotion, July/August, 1-15.
5.   Chapman, Larry.   (2006)   Employee Participation in Workplace Wellness Programs and Workplace Wellness Programs:  How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6):  431-432.
6.   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   The Role of Health and Wellness Coaching in Employee Health Promotion Programs.   The Art of Health Promotion, July/August, 1-12.
7.   Chapman, Larry.  (2007)   Proof Positive:  An Analysis of the cost-Effectiveness of Job Site Wellness.  Northwest Health Management Publishing, Seattle, WA.
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.   Edington, Dee.   (2001)   Emerging Research:  A View from One Research Center.  American Journal of Health Promotion 15(5): 341-349.
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.   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.   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.   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.   Partnership for Prevention.  (2008) Investing in Health:  Proven Health Promotion Practices for Workplaces.   http://www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.