A Call to Action: Creating a Culture of Health

2010 AHA Long Range Policy Committee Report

January 2011

A Call to Action: Creating a Culture of Health

• A bold call to action for hospitals and their employees to be leaders in creating a culture of health

– Background on hospital health and wellness programs

– Findings from a groundbreaking AHA survey on hospital employee health and wellness activities

– Examples of hospital best practices

– “How-to" recommendations for the field

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Why Health and Wellness?

• Hospital and health system employees play critical role in their communities to lead the way and serve as role models for healthy living and fitness

• Financial case for creating a culture of health through potential cost savings and improved employee recruitment and retention

• Hospitals and health systems contributing to achievement of national public health goals in Healthy People 2020

• ACA incentives to promote employee health and wellness

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Survey on Hospital Employee Health and Wellness Activities• National survey of hospital employee health and

wellness activities conducted May-June 2010• 876 responses

• nationally representative of all hospitals in terms of hospital size, teaching status, and census region

• urban hospitals and hospitals that were members of a health system slightly overrepresented

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Survey on Hospital Employee Health and Wellness Activities• Most hospitals (86%) have an employee health and

wellness program, the vast majority of which (80%) are directly administered by the hospital or health system.

• The top motivators for offering a program are to reduce healthcare costs, improve the health of employees and reduce absenteeism/presenteeism, improve employee morale and productivity, and provide an example to the community.

• The most common wellness programs offered include flu shots, EAP/mental health services, smoking cessation programs, and healthy food options.

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Survey on Hospital Employee Health and Wellness Activities• There is a wide variation in the percentage of hospital

employees participating in health and wellness programs, with 42% of hospitals reporting that at least half of their employees participate in one or more programs.

• Hospitals promote their wellness programs through health fairs (76%), health risk assessments (70%), and incentives (66%). The overwhelming majority of hospitals that offer incentives use positive incentives such as health insurance premium discounts or gift cards.

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Survey on Hospital Employee Health and Wellness Activities• Most hospitals (76%) require that employees participate

in at least one wellness program. Many hospitals also offer incentives for employees who complete a wellness program (50%) and achieve outcomes based on participation (39%).

• HRA completion, participation in weight management or smoking cessation program, and completion of a biometric screening are activities commonly linked to incentives. Hospitals with more than 200 beds are more likely to utilize incentives.

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Survey on Hospital Employee Health and Wellness Activities• Slightly less than half (47%) of hospitals that use

incentives discount between 5% and 20% of an employee’s monthly premium for participating in health and wellness programs.

• A third of hospitals that use incentives award employees who meet health and wellness incentives between $100 and $300 annually. An additional 41% of hospitals award $100 or less.

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Survey on Hospital Employee Health and Wellness Activities• One-third of hospitals have made an attempt to measure the

return on investment (ROI) of employee health and wellness programs, and only 7% have successfully measured ROI. Of those who have successfully measured ROI, the current median ROI of health and wellness initiatives is between 2:1 and 3:1.

• Eighty-two percent (82%) of respondents who measure ROI report that their ratio is equal to or exceeds expectations.

• The most common measures used in evaluating ROI are number of participants, number of completed HRAs, overall direct health care costs, number exercising regularly, and number achieving weight loss.

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Survey on Hospital Employee Health and Wellness Activities• Motivating employees over extended time periods,

financial restrictions or limitations, measuring program effectiveness, and creating a culture of health are noted as the most serious challenges to program effectiveness. Urban hospitals and hospitals with more than 200 beds find it more challenging to communicate to their employees about health and wellness activities.

• Getting better ROI data is the most important opportunity for improving health and wellness programs. Additional opportunities include providing more incentives to employees, providing new programs, and providing different types of incentives.

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Our Recommendations

1. Serve as a role model of health for the community.

2. Create a culture of healthy living.

3. Provide a variety of program offerings.

4. Provide positive and negative incentives.

5. Track participation and outcomes.

6. Measure for ROI.

7. Focus on sustainability.

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Recommendations

1. Serve as a role model of health for the community. • Use wellness programs as pilots to export to the whole

community as part of a population-based approach to health care

• Offer health and wellness program benefits to all dependents of employees

• Work with local employers to build an integrated, regional approach to health and wellness

• Provide free wellness programs at local community centers.

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Recommendations

2. Create a culture of healthy living. • Promote a holistic approach to wellness• Start commitment to culture change at the top—

with the CEO and the board of trustees• Consider creating a wellness department led by a

chief wellness officer who reports directly to the CEO

• Make changes to the work environment that promote healthy behavior

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Recommendations

3. Provide a variety of program offerings. • Include a health risk assessment (HRA) and biometric

screening in all hospital wellness programs• Implement at least one intensive coaching activity• Make smoking cessation mandatory for all employees

and subsidize and/or offer only healthy food options in all hospital cafeterias and vending machines

• Re-evaluate wellness programs annually and adjust as necessary

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Recommendations

4. Provide positive and negative incentives. • Expand use of incentives to improve participation

levels • Experiment with various types of incentives and

measure effect on participation and outcomes• Shift toward more outcomes-based incentives as

participation increases

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Recommendations

5. Track participation and outcomes. • Initially focus on measuring and increasing participation

levels, then move on to tracking outcomes • Track participation levels in a number of ways, e.g., number

of overall participants, number completing a HRA, number enrolled in smoking cessation programs

• Track outcomes in a number of ways, e.g., number who achieved weight loss, number who ceased smoking

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Recommendations

6. Measure for ROI. • Ensure multi-year commitment to measurement,

evaluation and improvement • Start small by measuring ROI on subset of wellness

programs • Focus attention on finding effective metrics—”hard”

and “soft”—that work for your institution• For validity, match employees who have undergone an

intervention with employees with similar characteristics who did not participate

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Recommendations

7. Focus on sustainability. • Approach wellness as a constant activity, not just an

annual event • Dedicate resources to constantly communicate—

through multiple modes and media—with staff, educate and incentivize participation

• If necessary, start small, demonstrate success, and build up to full range of wellness activities

• Change programs and incentives as necessary to maintain high levels of participation

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Health and Wellness Best PracticesHospital/Health System Best Practice

Truman Medical Centers, Kansas City, MO

“PTO for Wellness” program – allows employees to trade paid time off (PTO) hours for reimbursements for wellness-related expenses

Ochsner Health System, Jefferson, LA

Voluntary wellness program with significant insurance premium discount

Sentara Healthcare, Norfolk, VA

Mission: Health, an incentive-based wellness and disease management program

St. Elizabeth Medical Center, Wabasha, MN

Robust wellness program with numerous offerings that is managed by a wellness committee

HCA, Inc., Nashville, TN Calculates ROI of a diabetes pilot program in multiple ways, with a focus on clinical outcomes and claims-reduction data

Henry Ford Health System, Detroit, MI

Developing data collection methodology at beginning of interventional, controlled trial for chronic back pain with major employer provided data to expand program to other employers and community organizations

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A Call to Action: Creating a Culture of Health

20www.aha.org/wellness