Healthy Choices

Learn how to identify the health promotion needs in your company and develop a cost-effective wellness program.

Jane Miller has a greater appreciation for her company's health promotion program these days. That's because at Pennsylvania Blue Shield's annual health fair sponsored by the company's wellness program, which Miller oversees, she participated in a screening for osteoporosis. In her 30s, Miller is hardly considered at high risk for the disease, which is why she was surprised when the test indicated her body was verging on osteoporosis.

The good news is Miller went to see her doctor and, using a nutrition plan, has been able to reverse the effects of the disease. She is glad she found out about her condition in time to do something about it. "If it wasn't for the screening, I never would have known."

Why Wellness at Work?

Prevention and early detection, as in Miller's case, are two of the many reasons for a company to institute a wellness program, according to Kim Gladstone, MA, RN, ARM, director of the Well Aware health promotion program for BJC Health Systems in St. Louis.

"Another reason is because we have the time when we're at work," Gladstone explained. "People don't have time once they get home. They have every excuse not to do wellness stuff." Convenience is another factor. "It's easy for the employee to do wellness at work," she said.

Gladstone also cited the economies of scale. "It's a lot cheaper to do 200 cholesterol checks at once than to bring in people one at a time at the doctor's."

Perhaps most compelling are risks employers could subject themselves to by not instituting a wellness program. "Injuries, infectious diseases, high absenteeism, low productivity, high turnover and low morale -- these are all things that wellness programs work to prevent," Gladstone said.

Getting Started

"We try to get people to look at it as a business case," said Shelley Farnell, senior health education consultant for Capital Blue Cross in Harrisburg, Pa. According to Farnell, the most successful health promotion programs are those that are well-thought out before any actual dollars are invested. "Even if you have a minimal budget but a decent amount of time invested, any company in the world is going to want to see a return on that investment or at least cost-effective methods of spending that money or time," she said.

Farnell advised forming a committee that includes personnel from different areas of a company to oversee and provide input for the program. Pennsylvania Blue Shield's Miller, whose program serves 6,000 employees at the Harrisburg company, urged including employees at all levels, not simply representatives from management. "It needs to include people who are actually doing the work because these are the people you want to target the program to," she said.

Miller suggested including on the committee a cross section of employees you hope to target through the wellness program. "If you want to have a smoking cessation program, you might want to include on your committee people who smoke. These people can tell you how to get to the smokers. Get people who you want to affect through the program."

Gain Management Support

A key to the success of Pennsylvania Blue Shield's wellness program was management support from the start. "Before you do anything, you've got to have at least one or two advocates in management," Miller maintained.

Unfortunately, getting management to support a program is much easier said than done. "Just like other aspects of business, wellness is very bottom-line driven because most companies don't have money to burn," Farnell said. To gain management support, she suggested presenting a wellness program as an investment. "By coming up with a business plan, management sees that you've thought it through clearly."

Identify Your Company's Needs

Once you decide to develop a wellness program, the next step is to identify your company's needs. Farnell highlighted a number of areas to look into:

Employee demographics. According to Farnell, looking at employee demographics is a good way to pinpoint a company's needs. "If, for example, your population is primarily over 40, a prenatal program is probably not going to be all that pertinent to your employees."

An examination of employee demographics helped Pennsylvania Blue Cross design its program. "The fact that 80 percent of our employees are women was definitely a factor in determining what types of programs we would offer," Miller said.

Claims data and utilization figures. Another key to employee needs can be found through analyzing your company's claims data and health care utilization. "Look at the claims data and pull out the areas that are causing the most cost. Those are the areas your wellness program should target," Farnell said.

Absenteeism and safety records. Farnell suggests looking at absenteeism, "because a lot of wellness programs do affect absenteeism." Other potential sources of information include disability and safety reports, such as workers' compensation claims. "Back injury is one that has the potential to save a huge amount of money, and it's usually where workers' comp claims control heads first."

Culture audits. A great way to gauge the atmosphere at a company is by conducting a culture audit, an organizational feasibility study of sorts that identifies the level of resistance to change in an organization and whether it is spread uniformly throughout or lies in pockets associated with specific job levels or functions, or employee age or gender.

"An effective wellness program needs to fit the culture of a company," Farnell stressed. If it doesn't, chances are employees will not be inclined to participate. She encouraged surveying different groups across the company -- both blue-collar workers and managerial level employees -- to achieve the most accurate picture of a company's atmosphere.

Health screening data. Farnell recommended saving data from any health screening tests conducted on employees, such as cholesterol, glucose or blood pressure. "This is particularly helpful when a company does not have a high turnover, and it becomes beneficial from year to year because you can compare historical data."

Interest surveys. Interests surveys provide insight not into employees' habits but where their interests lie. This information is essential to designing a wellness program that is effective, according to Farnell. "You don't want to have a smoking cessation program, for example, if 50 percent of your employees smoke but zero percent are willing to change that behavior."

Developing Cost-Effective Programs

"The biggest mistake a company can make is throwing together something just for the sake of putting together a program," Farnell said. Instead, she advised focusing on results-oriented planning vs. activity-centered planning. She offered several tips for developing a cost-effective program using company and community resources.

Take advantage of in-house resources. Farnell said companies should be wary of putting all their eggs in one basket. Instead, she advised opting for a coordinated effort using a variety of community and in-house resources. She suggested using an interest survey to find out if employees have special skills and could contribute to the program.

At Pennsylvania Blue Shield, Miller was able to offer a low-impact aerobics class taught by an employee who was a certified aerobics instructor. Another class on self-defense was taught by an employee who was a former police officer. Miller's only caution is to make sure the employee is reputable. "Just as you would with any other resource, it's best to ask for references."

In addition to in-house resources, Farnell suggested using other resources available at a company. "If there's a conference room or an area of the factory not in use, consider putting in a fitness center." She said the chances of employees exercising at work are much better if they have an on-site facility.

Utilize community resources. For companies on limited or nonexistent budgets, free community resources are often the best bets for wellness programs. Miller suggested contacting local chapters of the American Heart Association, the American Lung Association and the American Cancer Society, to name a few, to give presentations to employees. "There are definitely community resources out there, but, as always, you have to do some research," Miller said. "A free program doesn't necessarily equate to a good program."

Conduct evaluations afterward. "It's one thing to put on a health fair every year and have several offerings that all employees attend, but if you don't collect the data, there's no way to gauge your success," Farnell pointed out. The importance of having data -- before and after a program -- is essential to demonstrating the effectiveness of any wellness program. "You have to be able to measure your results," Farnell stressed. Doing so provides evidence to management that a wellness program works.

Farnell suggested having employees complete evaluations after every program. "It's not enough to find that people enjoyed a particular program," she said. "Ask, for example, 'Are you more productive at work because you had that five-minute chair massage over your lunch hour? Do you feel like you accomplish more on the days that you have your massage?' " Such questions help measure a program's success.

Evaluations can aid in developing future programs. "If the evaluations after a cholesterol screening demonstrate that a lot of employees are concerned about high cholesterol, then maybe you should consider offering a nutrition class or a healthy cooking class," Farnell offered. "You can take those pieces of information, synthesize them and then take your program to the next level."

Miller said her company conducts evaluations after each lunch-and-learn program it offers. "As the planner of the program, you may think you know what employees want, but you can't really know until you ask them."

Offer incentives. Incentives are often the key to gaining employee participation in a wellness program, but designing an incentive plan can be challenging, according to Farnell. "You can't always throw a trinket their way and hope they'll always come back for that." Instead of spending $5 to $10 on mugs or hats, Farnell suggests companies offer employees a chance to win a day off with pay. "Paid time off and money are the two most desired incentives among American employees."

Be creative.With a small or nonexistent budget, creativity is essential to developing a viable wellness program, according to Miller. A company without a lot of money to spend bringing in experts to speak to its employees can offer presenters other incentives. "I tell them they get free advertising in the newsletter, which reaches 6,000 people, and many times speakers will come in because it helps them get their name out." She also suggested cost-sharing with employees.

Miller also encouraged being creative in choosing different elements of a wellness program. "Because stress is one of the issues that affects many of our employees, we decided to offer yoga and tai chi classes." While management was skeptical of these nontraditional programs at first, Miller said both have been so popular that her company had to add classes to accommodate all the interested employees.

Above all, a company must be willing to take chances with its wellness program. "You have to be open to new things and take a chance," Miller advised. "You really don't know if employees are going to like it or not until you actually do it."

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