Health Promotion and Wellness
Contents
1. Health Promotion and Wellness
Deciding on program components
Introduce the program to employees
4. Integrating information and management
Why the program is an example of good practice
1. Health Promotion and Wellness
Workplaces that care for the health and well-being of their employees have less work disability.
A workplace health program is a coordinated approach that aims to improve health of staff:
1. By informing and educating employees about ways they can improve their health
2. By motivating staff to improve their health
3. By increasing employee activity levels
4. By providing workplace systems that support health, such as healthy food within the cafeteria
5. Through individual health assessments in some situations.
Workplaces vary in the type of program introduced; however, consistent evidence suggests that well planned and implemented programs achieve positive outcomes. The benefits of the program for the employer include:
1. Reduced compensation costs
2. Reduced absenteeism (staff taking leave because of poor health)
3. Reduced presenteeism (staff in poor health attending work but performing poorly)
4. Improved productivity
5. Reduced staff turnover.
The benefits for the employee go beyond improving the employee's current health and wellbeing. Health programs involve promoting a healthy and active lifestyle to:
1. Improve the person's sense of well being
2. Improve the person's level of fitness (where appropriate)
3. Better manage current health conditions (e.g. the sugar level in someone who has diabetes)
4. Reduce the risk of future health problems (e.g. the development of diabetes from obesity)
To be effective the organisation needs to have a genuine commitment to the process. Simply arranging a series of blood tests through a local practitioner with review of results is insufficient. Employees take their lead from the organisation. Effective wellness programs:
1. Have a strong commitment to outcomes
2. Are led by senior managers
3. Have the well-being of staff at their core
4. Are supported by a strong corporate culture
5. Have a high level of worker participation
6. Measure results and evaluate program effectiveness
7. Include a variety of health promotion programs, such as blood pressure checks, exercise programs and smoking cessation campaigns.
Research shows that employees who are healthy (not just free from sickness) perform best. The difference is substantial and impacts productivity. One study demonstrated the average healthy employee works 143 effective hours per month, while an unhealthy employee works only 49 effective hours per month - 300% less.
Most businesses are conscious of compensation and turnover costs, and have strategies in place to minimise them. A focus on absenteeism is less common, however, and a focus on presenteeism is uncommon. Absenteeism and presenteeism are both high cost items in a number of organisations.
A 300% return on investment is a reasonable expectation for a well designed and implemented program.
2. Health and productivity
Health issues impact productivity. Understanding the factors that influence health and productivity helps employers decide about the content and approach of health promotion programs.
Absenteeism and presenteeism have the greatest impact on productivity. The ten conditions that cause the greatest loss of productivity are listed in the first column of the table below. The percent of employees who report they experience the condition is listed in the second column. In the third column is the proportion of lost productivity from that condition that occurs through presenteesim. The top condition is fatigue, which 56% of employees report experiencing. The majority of lost productivity from fatigue is via presenteeism, as opposed to absenteeism or staff turnover or compensation costs.
| Top ten productivity affecting conditions
| Percentage of Australian workers with the condition
| Proportion of productivity cost due to presenteeism
|
| Fatigue | 56% | 71% |
| Depression | 12% | 73% |
| Back/neck pain | 29% | 68% |
| Sleeping problem | n/a | 73% |
| Other chronic pain | n/a | 44% |
| Arthritis | 11% | 56% |
| Hypertension | 11% | 60% |
| Obesity | 28%* | 54% |
| High cholesterol | 9% | 58% |
| Anxiety | 10% | 76% |
*Note that this refers only to employees who are clinically obese. Clinically overweight employees make up another 34% of the Australian workforce, meaning that 62% of the Australian workforce are overweight or obese.
In aiming to address health related productivity there are two goals for the employer to consider:
· Helping employees who have a condition
· Helping the workforce to achieve improved health in order to reduce their chances of developing a condition.
Helping employees who already have a condition is usually a matter of providing access to appropriate services, within the organisation or externally.
The preventative goals of health and wellbeing programs are more complex.
The sensible approach is to identify modifiable risk factors. Modifiable risk factors increase the likelihood of health problems developing, but can be altered by changes in behaviour (unlike factors such as genetics). The most important modifiable health risks are:
· Smoking
· Physical inactivity
· Poor diet and nutrition
· Overweight/obesity
· High blood pressure
· High blood cholesterol
· Stress.
How does an organisation go about addressing these priorities?
The first decision to make is whether to design and operate the program using the organisation's resources or to engage an external organisation.
Both approaches can work well. Strong systems are required, so if the program is going to be run internally competent project management skills will be needed.
There are a number of professional organisations with skills and expertise who work with organisations to design and implement workplace health programs.
Many programs will combine strategies such as health checks or health promotion about a particular condition, and follow up.
3. Program steps
Gathering information
The initial step in designing an effective health and wellbeing program is the collection of information on:
Absenteeism levels in the organisation
Collecting absenteeism information is simple. In the most organisations absenteeism information exists through central records.
Useful information to include in the assessment of absenteeism includes:
a. The total number of sick days taken
b. The proportion of working hours this represents
c. Common causes of absence (if known)
d. Trends in the amount of sick leave taken
e. The departments or workplaces prone to absenteeism
f. The prevalence of chronic absenteeism.
Presenteeism levels in the organisation
Measuring presenteeism is more complex and requires work to collect specific information. There are a number of surveys that can be used to analyse presenteeism. The Health and Work Performance Questionnaire (HPQ) is one of these. The HPQ was developed by the World Health Organisation and Harvard University. The questionnaire can be delivered to employees face to face, in written form, over the phone, or online.
The questionnaire has a simple guide to producing estimates on absenteeism and presenteeism. It also indicates the health conditions that may be appropriate to focus on for the health and wellbeing program.
The health conditions that most affect the organisation
The list of conditions that cause the greatest impact on organisations in the table above is a good staring point. However, each organisation may have its own unique priorities.
An organisation with outdoor workers may focus on prevention of skin cancer. A workforce with a sedentary workforce may focus on improving levels of exercise.
Deciding on program components
Four broad options
There are four broad strategies commonly adopted in health and wellbeing programs. Each one can be used by itself, but together they form a comprehensive program.
1. Education, training and health promotion programs
2. Individual health assessment and advice programs
3. A review of organisational factors that contribute to health and wellbeing, such as organisational culture, job expectations and work environment.
4. Practical activity programs.
The budget and the nature of the workplace will influence whether one or a combination of approaches is incorporated.
1. Education, training and health promotion programs
Providing information to employees to promote healthy behaviour is central to health and wellbeing programs.
Promoting healthy behaviours is an essential plank in the process of “leading the horse to water" and provides a platform on which other program components are developed and implemented.
Decisions need to be made on:
· Which health topics will the program focus on?
· How will the information be communicated to employees?
The first question is the easiest to answer. The most effective way to choose is to assess the problems impacting the workplace and plan the best approach that takes into account the available budget. Which conditions are common in the workplace? Which health behaviours are lacking?
Using a range of communication methods is wise:
a. The simplest approach is to provide employees with written information. Relevant posters, booklets and fact sheets can be obtained from organisations that provide health program services either for free or at a small cost. On its own this information will be of limited use, especially if the same resources are distributed to all employees.
b. Targeted programs can be arranged through commercial organisations providing health and wellbeing programs.
c. A number of organisations now use web based resources, such as a website with logons for individual employees, or regular newsletters.
2.Individual assessment and advice program
Individuals undergo a health assessment, noting
a. The program is voluntary
b. Employees who accept are assessed by a nurse or doctor, or by a method such as a blood test for cholesterol. Assessments typically include a questionnaire, physical examinations and tests.
c. If any health conditions are detected, a doctor provides a diagnosis and appropriate treatment or referral
d. Feedback and advice is given regarding health findings.
This approach is more expensive, but it can be very effective.
3. A review of organisational factors that contribute to health and wellbeing
One of the simplest steps to improve employee health and wellbeing is to review the work environment and a job’s impact on staff health.
a. Workplace atmosphere and culture
Do employees feel they have the opportunity to achieve work/life balance? What is the impact of stress at work? Are they valued for their contribution?
Employees who feel overwhelmed by work expectations are likely to be more stressed.
High levels of stress can have a significant impact on health. High levels of stress contribute to common problems of fatigue, depression, hypertension and anxiety. If employees report high levels of stress or find it hard to achieve balance in their lives, health and productivity are likely to be affected.
Stress is often higher in some departments than others. If so, consider the issues in departments that lead to reports of high stress levels. What lessons can be drawn from departments performing better?
b. Providing a healthy environment
There is a great deal that employers can do to provide a healthy work environment. A healthy environment lets staff know they are important, and reinforces the intent of the health program. Simple practical measures make a difference. For example, one option is to support employees to have a healthily diet while they’re at work. Providing a refrigerator and a microwave makes it easier for employees to bring their own food from home. Healthy food in the canteen or cafeteria helps; however, it needs to be an attractive option or employees won’t choose to purchase it.
4.Practical activity programs
Exercise promotion can be encouraged through a number of methods: posters to encourage employees to use stairs or walk, establishing a gym on site, or starting a ride to work group.
Organisations have supported employees to engage in local charitable walk days, and some provide pedometers so staff can check they are getting adequate levels of exercise.
Choosing and integrating program components
The practicalities and costs of each option needs to be considered.
For example, a ride to work program won’t be effective unless there is a good bicycle route near the workplace and a significant number of employees live within a reasonable distance of the workplace. Further, if a ride to work program is going to be effective, facilities for employees to shower and change at work will be needed.
The culture of the organisation needs to be considered. Some measures are likely to get a good response from particular workforces, while others are likely to strike the wrong note.
Once the program approaches have been chosen, a plan to integrate the steps should be drawn up. If an external provider is to be engaged, program integration should be discussed with the provider.
For example, a general health promotion on two topics could include in-depth information sessions on diabetes and depression.
Health promotion efforts (e.g. a newsletter and posters in the workplace) are best to focus on one condition at a time, with the focus sustained for six months. This is followed by health promotion of the next most important health condition, and so on.
Not all measures need to be integrated, but it is sensible to have a “big picture” sense of the way they fit together, and the ways in which each element contributes to the goals and priorities identified from the needs assessment.
Introduce the program to employees
The way in which the program is introduced to the workforce will affect success as much as the design of the program.
The program itself will not improve employees' health, rather it gives staff information and opportunities that enable employees to improve their own health. Employees' interest and enthusiasm for the program is vital for success.
Positive goals including good health, achieving wellbeing and increasing productivity should be the stated aims of the program.
The program is not only for employees. Supervisors, managers and senior leaders are part of the workforce and for the program to be taken seriously all levels of the organisation should be involved.
Statements about productivity improvements should be communicated sensitively. If staff are left with the impression the program is aimed at improving employee performance, it could lead to negative perceptions of the program, which will be counterproductive to the program's effectiveness. Reference to "our productivity" is preferable to "getting employees to lift their game".
Be honest about the likely benefits of the program and the organisation's motivations for its introduction. It is sensible to let employees know about any planned evaluation steps that led to the decision.
Think creatively to build enthusiasm. A competitive, male-dominated work culture might be won over by a competitive athletic event. The event will not generate sufficient enthusiasm for the health and wellbeing program by itself, but can provide a starting point.
“Selling points” will vary depending on the workplace. Academics at a university may be more interested in the published evidence supporting the value of health and wellbeing programs. Other workforces may be more interested in the calming effect of exercise and good diet.
In some workplaces it can be better to start with a small group as a pilot, or simply to demonstrate success in one group and build on that success.
Senior manager engagement and leadership will enhance the program's effectiveness. Senior manager involvement increases the involvement of middle managers, and in turn this permeates to other levels of the organisation.
Program monitoring
The program requires ongoing evaluation and monitoring.
Research shows that most employers are disproportionately focused on the introduction of a program and participation in the program. A focus on outcomes increases the program's success. Outcomes of interest can be evaluated through:
· Ongoing collection of absenteeism information
· Ongoing collection of presenteeism information
· Ongoing collection of health information from health assessment program (if introduced)
· Monitoring employee participation rates.
It is important to ask employees for feedback on the program and suggestions for improvements.
These five measurements will provide strong measures of program effectiveness.
Program evaluation provides an opportunity to respond to new developments in the information collected. It might emerge, for example, that while the program has produced improvements in some areas, rates of obesity have increased. This naturally leads to the introduction of the next element of the program or redesign of an element already in place.
4. Integrating information and management
Integrating information and ongoing program management is essential to good outcomes.
It is sensible for health and wellbeing management efforts to be concentrated in a single department. This results in all data being held in one database.
This responsibility for health programs and their evaluation should be vested in the same place as the responsibility for compensation and insurance costs. This streamlined and comprehensive approach at a single point allows the organisation to see the big picture of health related costs and make long-term strategic responses.
Research has shown that integrated management of health and wellbeing produces the best result. It also avoids cost shifting between departments.
5. Program example: the Western Australian Local Government Association (WALGA) health and wellbeing program
WALGA is the peak representative body for the 142 local governments of Western Australia (WA). In 1995, WA local governments were among the worst performers in terms of health and wellbeing, and especially in terms of workers compensation. At this time, WA local governments employed approximately 10, 000 people and received an average of 880 compensation claims each year. One employee in four submitted a compensation claim at some time during their employment.
Things began to change when WA local governments became collectively self-insured and set aside 10% of their total insurance pool for a preventative health and wellbeing program. All local governments were offered the opportunity to participate.
Program design
The WALGA health and wellbeing program was divided into three branches:
- A health assessment program provided by doctors
- A SunSafe screening and education program
- A training program.
Every branch of the program was designed in consultation with an external commercial provider. The actual operation of the program was also managed by this commercial provider. Employees were invited to participate in each branch of the program.
Detailed information on each branch of the program is provided in the text boxes below:
|
1 - Health assessment program This service was offered to all employees, whose participation was voluntary. The employee saw a doctor who conducted an in-depth examination of the person’s health, including the testing and examinations recorded below:
Following their assessment, employees were given detailed feedback and information on their health and what they could do to improve it. Referrals to specialist services were made where appropriate. 19, 000 assessments were made between 1996 and 2006. The person also received a follow up consultation two years after the initial assessment to check on their progress. |