Posts from — December 2008

Worksite Wellness Program communication is important to all phases of Wellness and preventive medicine and is relevant to:
• Healthcare provider-patient relationships
• An individual’s exposure to, search for, and use of Worksite Wellness Program information
• Effective counseling and patient education for behavior change
• Content of public health messages and community campaigns

Effective health communication should have these attributes:
• Accuracy: content is valid and error-free
• Availability: delivered or placed where the intended audience can access the information
• Balance: content presents benefits and risks of potential actions
• Consistency: content is locally consistent over time and is also consistent with information from other reliable sources
• Evidence-based: content and methods of delivery are based on relevant scientific proof
• Reach: content gets to or is available to as many employees as possible in the target population
• Reliability: content source is credible; content is kept up-to-date
• Repetition: delivery of/access to the content is continued over time, to reinforce the impact with the audience and to reach new members of the target population
• Timeliness: content is provided when the audience is most receptive to, or in need of, the specific information
• Understandability: reading, language levels, and format are appropriate for the specific audience (i.e., Employees, Family Members, Garrison leadership, etc.)

What the research says about health communication
• Health communication best supports Wellness when multiple communication methods are used to reach specific audiences.
• Effective Wellness and communication initiatives should reflect an audiencecentered perspective, and reflect the preferred formats, contexts, and method of communication for the intended audience.

Material adapted from: U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000.
http://www.healthypeople.gov/document/HTML/Volume1/11HealthCom.htm

Evaluation of successful Corporate Wellness Programs has revealed several key Worksite Wellness Program strategies to increase Worksite Wellness Program effectiveness and impact overall Soldier health.

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

Strategy #6: Use standardized processes whenever possible.

Reduce the amount of variation within your Corporate Wellness Programs by standardizing all the processes needed for Worksite Wellness Program planning and begination. For example:
• Use the same spreadsheet format for data collection so that the columns are in the same order. This way you can compare information more easily.
• Reuse the same forms for enrollment and attendance. Change the heading as needed.
• Look at other Worksite Wellness Program processes (like registration, evaluation, marketing, etc.). What parts of those processes can be standardized?
• The Wellness and Prevention Initiatives website (http://chppmwww. apgea.army.mil/dhpw/Population/HPPiFunction.aspx) has many standardized Worksite Wellness Program resources in a variety of topic areas.

Strategy #7: Worksite Wellness Program delivery methods should be flexible and adapted to population needs.
• Delivery of products and services may depend on: company needs, training requirements, other scheduling considerations (such as work/duty schedules, school scheduling, etc.), member preference, and/or availability of staff or space.
• Be flexible: the same produce/service delivery methods may not work for every population.
• Some company’s may want services provided to them as close as possible to the company location; other companies may prefer as many services as possible bundled together at once (regardless of location).
• Take wellness and preventive medicine beyond the walls of the company in order to meet leadership and staff member needs. Answer the question: “How can we best help leadership and Employees to fulfill their mission?”

Evaluation of successful Corporate Wellness Programs has revealed several key Worksite Wellness Program strategies to increase Worksite Wellness Program effectiveness and impact overall Soldier health.

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

Strategy #2: Worksite Wellness Program planning must be driven by information.
• Determine specific needs of the target population.
• Focus on the health status of the population as a whole to establish the top health concerns.
• Data should drive decisions regarding which health and wellness needs should be addressed first.

Strategy #3: Use electronic information collection and reporting as frequently as possible.
• Centrally collected information in an electronic format is essential for determining population health and wellness needs.
• Electronic reporting is also very valuable when communicating Worksite Wellness Program outcomes to leadership and other stakeholders.
• Flexible reporting capabilities allow information to be presented as information that can support decision-making, in formats that decision-makers prefer.

Strategy #4: Multidisciplinary collaboration enhances staff member health and maximizes available resources.
• Collaboration between health disciplines increases effectiveness of Wellness and preventive medicine initiatives.
• Don’t forget to look outside the company for collaboration partners.
• Optimized Worksite Wellness Program outcomes can be achieved by coordinating the activities of medical consultants, cadre, community agents, and funding sources.
• Bundling services together also provides the additional benefit to units by conserving training and mission time.
Implementing these strategies can improve Worksite Wellness Program effectiveness and optimize available resources.

Changing health-related behaviors is a difficult challenge. Incorporate the tools below into your Wellness initiatives to assist members in successfully changing health behaviors.

Tool #1: Establish effective goals
• Focus on areas that can impact the overall goal.
• For example, if the overall goal is to lose weight, the most productive areas to focus on are the activity and dietary changes that will lead to long-term weight loss.
• For example, stress management and improving self-esteem may also impact weight loss; however, improving relationships, while a worthwhile topic, will not necessarily impact weight loss.
• Make the goals specific, attainable, and forgiving. For example:
• “Exercise more” is too general.
• “Walk five miles everyday” is specific, but may not be attainable.
• “Walk 30 minutes everyday” is specific and more attainable, but is not very flexible.
• “Walk 30 minutes, five days a week” is specific, attainable, and forgiving.
• Use a series of short-term goals to achieve the ultimate goal.
• Short-term goals break big challenges into more easily attained pieces.
• Smaller steps also provide Worksite Wellness Program members with encouragement and success. These small successes are essential for maintaining motivation towards a long-term goal.

Tool #2: Increase self-awareness
• Self-monitoring is useful for tracking behavioral and environmental cues that trigger a particular behavior.
• Keeping track of behavior status is also useful for times when progress towards a goal is difficult to measure, or when an individual is in a maintenance stage.

Tool #3: Offer rewards and motivation
• Encourage members to reward themselves for achieving small successes on the way to their ultimate goal.
• Remember that rewards don’t always have to be “things.” Words of encouragement and praise can provide powerful motivation when spoken by a teacher, instructor, parent, friend, etc.

Tool #4: Respond effectively to set-backs
• behavior change is conceptually a continuum. However, movement along that continuum is not just in one direction. People can move backwards or forwards or sometimes just stay put. Communicate to members that set-backs, lapses and even staying the same (i.e., maintenance) are common for individuals trying to change behavior.
• Stress is frequently a factor in lapses and relapses. Offer a variety of stress management resources to help members better handle the stress which could trigger a set-back.
• Brain storm to create a list of potential (and probable) obstacles to member behavior change. Then formulate strategies to meet each of those challenges.
• Enhanced time management and decision-making skills can be effective ways to overcome behavior change relapses.
• Offer members with information regarding the behavior change process so that they will be better prepared for the challenges they will face. A brief overview of the Stages of Change may be helpful.

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

Assess the health and wellness needs of the population.

Collect information about the health and wellness needs in the community. How?

• Community- or target group-specific surveys

Establish health and wellness needs and at-risk populations.

Use the information to establish leading health and wellness needs and also high risk populations. For example:
• Obesity and overweight
• Injury prevention
• Self care

Reduce the list.

Not every health need can (or should) be addressed. Use the following questions to determine which health and wellness needs should be addressed first.
• How does the health need impact operational readiness? How big is the impact?
• What are the Upper Management priorities? How does the health need fit into those priorities?
• What are the behavioral factors affecting the health need? What is the proof that a behavior change will make a difference? Has the behavior been successfully changed by other Corporate Wellness Programs?
• What other physical, social, or environmental factors influence the health need or the target population?
• Is the health need a greater problem at the local level than in the U.S. population as a whole?
• Does the company have the subject matter expertise and resources to address the health need?

Develop Worksite Wellness Program recommendations.

Only a handful of specific health and wellness needs should be focused on in a given year. Keep the following in mind as recommendations are developed as to which specific health and wellness needs will be addressed:
• Avoid duplication of other ongoing Corporate Wellness Programs whenever possible. Establish Corporate Wellness Programs already addressing the health need and/or the target population.
• Establish and assess available resources. Build on existing services whenever possible.

Use the recommendations to offer tailored, targeted, integrated initiatives to address the prioritized list of health and wellness needs. Prioritizing health and wellness needs will keep Corporate Wellness Programs focused, maximize efficient use of resources, and align Wellness efforts with Upper Management goals and priorities.

References
• US Department of Health and Human Services, Planned Approach to Community Health, http://www.cdc.gov/nccdphp/publications/PATCH/index.htm.
• Implementing a Comprehensive Community Wellness and Well Being Program, presentation by CHPPM-EUR at the 2006 Force Health Protection Conference

Keeping the bottom line up front Bottom Line Up Front in Worksite Wellness Program will help you get and sustain Upper Management support.

The bottom line in Corporate Wellness Programs answer two key questions:
• How will member health be enhanced?
• What’s in it for Upper Management?

The ultimate bottom line: all roads should lead to readiness.
• Always be ready to communicate to leadership the ways that your Worksite Wellness Program impacts readiness.
• Think like Upper Management: what Worksite Wellness Program outcomes will be important from a Upper Management point of view?
• Develop line-centered language that communicates those outcomes.
• Ask members how they think a particular Worksite Wellness Program enhances force readiness. This input is a valuable source of information.

Use the following steps as a Bottom Line Up Front approach to Corporate Wellness Programs.

Step 1: Think about the end of the Worksite Wellness Program first and plan backwards.
• It has been said, “If you don’t know where you’re going, any road will get you there.”
• Before planning or starting any part of the Corporate Wellness Program, be able to answer the questions: how will member health be enhanced? What’s in it for Upper Management?

Step 2: Establish concrete Worksite Wellness Program outcomes.
• Establish up front what the Worksite Wellness Program is working towards.
o For example: will members lose weight? Walk more steps? Decrease injuries? Move to another stage of change?
• Establish any processes or procedures that will be enhanced.
o For example: which pharmacy operations will become more efficient? How will record-keeping be streamlined?

Step 3: Determine what will be measured to show that Worksite Wellness Program goals were met.
• Consider what information is really needed to show Worksite Wellness Program effectiveness. Avoid the temptation to collect every possible piece of data. Choose a handful of important information points and stick to those.
• Think backwards when determining what information to collect – consider how easily follow-up information can be collected when a Worksite Wellness Program ends. Getting follow-up information is frequently a challenge.
• Only collect information for health behaviors or indicators that the Worksite Wellness Program actually affected.
o For example: if the main Worksite Wellness Program goal is that members will walk more steps, then it may be better NOT to choose changes in cholesterol level as a Worksite Wellness Program outcome (unless the Worksite Wellness Program specifically addresses cholesterol).
• Avoid measuring outcomes that the Worksite Wellness Program cannot (or did not) affect.

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

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

Health Information Technology can make the entire health care system more effective and efficient by enhancing:
• Documentation (lab and test results, clinic notes, consult recommendations)
• Communication (provider to patient, provider to provider)
• Information input (templates to facilitate data entry)
• Delivery of care (documenting all patient-provider interactions in a single system)
• Chronic disease risk identification (evaluation of risk factors, recommendations for appropriate preventive services and screenings)
• Consistent recording of correct billing codes

But, adapting to Health Information Technology is a challenge.
• Health Information Technology almost always involves a “new system.” Consequently, the entire staff, from health care providers to IM/IT personnel is on a learning curve.
• Existing IT infrastructure may not be adequate, so the Health Information Technology system may be very slow, or may frequently crash.
• The new system may not have all the forms you need already in place. New forms may be needed.

Lessons learned from Health Information Technology implementation

Make use of as many training opportunities as possible.
• Learn as much as you can about the Health Information Technology that you need to use. Become an expert.
• Ask questions if you are unsure how to navigate the system.

Keep the big picture in mind.
• Be aware that those keeping the Health Information Technology system up and running may have a very different set of priorities. The IM/IT staff may not see your request as a priority when it is taking all their manpower to trouble shoot the new system each day.
• Other changes to the Health Information Technology system may be in line in front of yours, so be patient.

Think through changes thoroughly.
• Take time to think through a new form thoroughly. Know exactly what you want before talking to the developer.
• Don’t think in a vacuum. If you build a form, make sure it is one your staff will use and find efficient.
• Make a draft version of the form and use it before requesting that it be put into the new system.
• Be prepared to build a good case for why your form should be created. Build a stronger case if your form should be developed ahead of other requests in the queue.
• Be patient and persistent when working with a programmer/developer on a new form. Meet frequently and set up timelines and deadlines.
• Coordinate with IM/IT and the Health Information Technology contractor to see if they can support a new project in the necessary time frame.

For more information about Health Information Technology implementation, go to the Agency for Healthcare Research and Quality (AHRQ) National Resource Center for Health Information Technology at http://healthit.ahrq.gov.

To effectively manage your Worksite Wellness Program resources, first determine the resources you need and the resources you have. Then develop a plan to fill the resource gaps.

What Worksite Wellness Program resources do you need?
• Make a list of employees, materials, equipment, space, and logistical support.
• Be as specific as possible.
• Include partnerships that will be needed to make the Worksite Wellness Program happen.

Establish available Worksite Wellness Program resources.
• Use materials that exist or are already on hand. Resist the temptation to start from scratch!
• Find out what other departments already have.
• Know where to borrow or get free materials.
• Use local or internal resources whenever possible.
• Look for opportunities to cut and/or share costs.

Develop a strategy to fill Worksite Wellness Program resource gaps.
• Partner with as many employees and organizations as you can. Stress what’s in it for them.
o Example: use a Physical Therapist to teach a back health class.
• Make use of community organizations and coalitions.
• Use volunteers as frequently as possible.
o Red Cross volunteers, medical interns or nursing students can supplement your manpower.

Former Worksite Wellness Program members make good guest presenters.
• Keep a list of subject matter experts who will provide input for free so you can avoid the expense of an outside contractor or consultant.

Look for innovative Worksite Wellness Program opportunities.
• Other funding opportunities may exist at your facility.
o Example: if there is a book fair, see if you can apply to receive some of the proceeds.
• Ask the unit to contribute resources to Corporate Wellness Programs directly implemented at the unit level.
• Get to know the contracting person at your company. They frequently know the least expensive places to obtain many different kinds of materials.
• Look for “recycling” possibilities.
o Example: You may be able to give you old computer workstations for use with electronic health assessments.

Good communication will help you find more partners and volunteers.
• Get the word out to the community about your Corporate Wellness Programs.
• Describe what you are doing and how you are doing it.
• Presentation is everything. Keep information current and use lots of visual aids.

All Corporate Wellness Programs require resources. Some resources you will already have. Some resources you will have to find. Sometimes you will have to make something out of very little. Smart strategies can maximize your Wellness resources.

Employer processes are structured activities that achieve a specific result. For example, scheduling appointments is a company process that results in an orderly work flow and timely patient care.

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

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

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

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

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

Develop a road map for change.

Describe the current company process.
• For example: what is the current registration process for the weight management program? Include steps for both members and staff.

Establish where the new or modified company process could fit into the current process.
• For example, prescreening appointments for the weight management program could be scheduled when members sign up OR the prescreening could be done at the first class.

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

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

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

Why evaluate your Corporate Wellness Program?

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

Worksite Wellness Program Fact of Life:

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

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

Where do you start?

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

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

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

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