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Generating & Measuring Healthy Workplace Outcomes
Health Work & Wellness ConferenceSeptember 30, 2010
Peter Melnyk PhD & Allan Smofsky
Agenda
- Literature review: WHP in Canadian worksites
- Components of Canadian WHP strategies
- WHP program evaluation
- Literature review: WHP in Canadian worksites
- Components of Canadian WHP strategies
- WHP program evaluation
- Emerging definition of healthy workplace: what it means to different stakeholders
- Measuring healthy workplace outcomes
- Generating healthy workplace outcomes: some emerging opportunities
- Emerging definition of healthy workplace: what it means to different stakeholders
- Measuring healthy workplace outcomes
- Generating healthy workplace outcomes: some emerging opportunities
Employer survey:
- Focus on Canadian employers
- New/emerging strategies
Employer survey:
- Focus on Canadian employers
- New/emerging strategies
where are we now? where are we going?
Background evolution of WHP understanding:
“a marketing process which produces widespread and
sustained employee participation in
healthful activities”1
employee health is a combination of
personal and worksite inputs
more comprehensive WHP initiatives need a more scientific approach: clear objectives and well defined endpoints/outcomes robust evaluation of program outcomes clear positioning/integration of WHP within the corporate culture
1. Wilbur CS Prev Med 1983;12(5):672-81
Initial Objectives
Review the biomedical literature and other publicly available sources of information on the topics of:
workplace health promotion (WHP) and disease management in Canada
to identify:
best practices key clinical humanistic and economic outcomes measured in WHP evaluation
most articles were retrieved from a structured PubMed search of peer-reviewed literature:
approximately 35 studies meeting the search criteria were published and indexed by PubMed over the last 5 years
other sources investigated: Canadian Association for Population Therapeutics (CAPT) meeting abstracts, Public Health Agency of Canada, Canadian Healthy Workplace Council
Methods
screening abstracts
full text screening
data extractionPubMed
key search terms
General Results I
the Canadian WHP programs identified primarily targeted:
cardiovascular health, general health, musculoskeletal disorders
disease management – absent from the peer reviewed literature..
1. Public Health Agency of Canada. Active living at work - Trends & impact: the basis for investment decisions. 2007. http://www.phac-aspc.gc.ca/alw-vat/trends-tendances/index-eng.php
cardiovascular, musculoskeletal,
respiratory,digestive, cancer, stress.
70%
benefit costs1
otherdisease categoriesthese
conditions are preventable or modifiable
through behavioural
changes
Key factors that contribute to successful WHP initiatives are:
General Results II
Successful WH
Strategy
Targeting several health issues
Attaining high participation
Integrating WHP into the organization’s culture and
operations
• Integration of occupational health and safety with workplace wellness:
• enhanced effectiveness
• employee receptivity
• time & access .on-site services
• incentives
``
Increasing focus among employers on employee health and well-being much of the focus has been on education to modify personal health practices studies report that—to be truly effective—a workplace wellness program must consider
appropriate organizational and policy changes
2009 Buffet and Company2 survey (N=634): many initiatives not designed to
generate outcomes (e.g. flu shots)
Workplace Wellness Programs in Canada
2. Buffet and Company. 2009 Wellness Survey.,3. Stewart N. The Conference Board of Canada, 2010
0
10
20
30
40
50
60
70
80
90
100 91%
44% offer some type of wellness initiative
1997 2009
2010 Conference Board of Canada Survey (N=255):3
Workplace Wellness Programs in Canada
3. Stewart N. The Conference Board of Canada, 2010
0
10
20
30
40
50
60
70
only 26% of respondents reported that their organization has fully developed a comprehensive wellness strategy
64% of survey respondents agreed that their benefit programs focused on health promotion and disease management, but…
The most commonly offered elements of WHP initiatives among Canadian employers include: employee assistance programs: 94-97% CPR/first aid training: 84% flu shots/immunizations: 78-83%
The least commonly offered components: on-site medical care: 19-21% 24 hour nurse line: 22% fitness counselling: 17-22%
There is variability in the types of components offered in different regions of Canada
Components of WHP programs offered in Canada
• often offered as stand alone measures not strategically
incorporated as part of a comprehensive WHP approach
• conclusive evidence on the impact of EAP on performance is needed
Data on employee health/well-being is typically gathered using a macro perspective which is difficult to reconcile with the more granular employee
engagement/productivity data
Lack of robust data collection in the area of employee health: The literature describes a number of reasons for this
many managers simply accept that healthier employees are more productiveemployee health not consistently managed or monitored by health professionalshuman resources professionals may not receive training necessary to interpret
and manage employee health and wellness resources/tools available
Program evaluation I
Program evaluation is a key component of long-term success; however detailed measures of WHP program impact on health risks, employee productivity and costs are often not collected
Tune Up Your Heart1 – designed with a focus on measurement and evaluation of health outcomes
risk assessment; tailor intervention to risk strata measurements of systolic and diastolic blood pressure, lipid levels & BMI smoking and diabetes status were determined pre/post analysis of statistically significant changes in components of risk historical data: annual per capita costs for life insurance, absenteeism, STD, LTD and prescription drugs
Outcomes: components of risk risk status economic outcomes
Program evaluation II
1. Chung M, et al. Worksite health promotion: the value of the Tune Up Your Heart program. Popul Health Manag. 2009 Dec;12(6):297-304.
Health & Well-being Primary health and well-being outcome measures
used in studies identified in the literature search:
body mass index short term disability
blood pressure cholesterol and triglyceride levels self-reported stress level smoking cessation rate
Other metrics?
Evaluation metrics
Economic Primary economic/productivity outcome measures used in identified studies:
absenteeism WCB costs short-term disability claims annual grievances
Evaluation of WHP success or failure not based on any single metric
Evaluation metrics
Defining a Healthy Workplace – current (Canada)
Safe & Healthy Work Environment
Supportive
Organizational / Work
CulturePersonal H
ealth/
Lifestyle Practic
es
Healthy, Productive, Successful Workplaces
WHO Definition of Health
Health: A state of complete physical, mental and social well-being, and not merely the absence of disease
Workplace Health (new): A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace by considering the following, based on identified needs:
health and safety concerns in the physical work environment health, safety and well-being concerns in the psychosocial work environment, including
organization of work and workplace culture personal health resources in the workplace; and ways of participating in the community to improve the health of workers, their families and
other members of the community.
Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010
Safe & Healthy Work Environment
Personal Health / Lifestyle
Resources
Corporate Social Responsibility
Supportive Psychosoc
ial Work
Environment
Mobilize
Assemble
Assess
Prioritize
Plan
Do
Evaluate
Improve
LeadershipEngagement
Employee Involvement
LeadershipEngagement
Employee Involvement
Healthy, Productive, Successful Workplaces
Healthy, Productive, Successful Workplaces
Defining a Healthy Workplace- new
Adapted from World Health
Organization, 2010
Safe & healthy work environment includes: Physical work environment: structure, air, machinery, furniture, products, chemicals,
materials and production processes in the workplace¹ Process Elements
Ergonomics Emergency response Injury prevention Disability case management Environmental practices
Culture Elements Assessing impact of work culture on health & safety performance Supervision Empowerment Teamwork Workload Harassment/bullying prevention & management
¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010 http://www.who.int/occupational_health/publications/healthy_workplaces_model.pdf
Defining a Healthy Workplace
Personal Health / Lifestyle Resources include: The health services, information, resources, opportunities, flexibility and otherwise
supportive environment an enterprise provides to workers to support or motivate their efforts to improve or maintain healthy personal lifestyles, as well as to monitor and support their physical and mental health¹
Awareness / prevention, risk identification / prioritization, and targeted support
Disease management
¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010 http://www.who.int/occupational_health/publications/healthy_workplaces_model.pdf
Defining a Healthy Workplace
Supportive psychosocial work environment includes: Organizational culture as well as attitudes, values, beliefs and daily practices in
the enterprise that affect the mental and physical well-being of employees¹
Enshrining importance of employees in org. mission/vision/strategy Effectively communicating this both internally & externally Developing policies that reflect this
Management practices; walking the talk! – making people policies “real”
Understanding employee drivers, attitudes and perceptions
Work flexibility; work-life balance
“Fair work conditions" : Work demands are reasonable Input/decision making is maximized Feedback & recognition are adequate
¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010 http://www.who.int/occupational_health/publications/healthy_workplaces_model.pdf
Defining a Healthy Workplace
Job Satisfaction > Job Stress
Defining a Healthy Workplace
Corporate Social Responsibility (CSR) includes: The activities in which an enterprise might engage, or expertise and resources it
might provide, to support the social and physical wellbeing of a community in which it operates. This particularly includes factors affecting the physical and mental health, safety and well-being of workers and their families¹
Examples Supporting community health awareness/prevention campaigns/initiatives Environmental awareness/practices Providing leadership, expertise and support related to comprehensive workplace health to
other businesses
¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010 http://www.who.int/occupational_health/publications/healthy_workplaces_model.pdf
¹¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010
Implications for organizations: providing opportunities for employees to participate in CSR activities (e.g. Habitat for Humanity) can enhance employee engagement in addition to supporting the organization’s CSR strategy and benefitting the community
Primary Drivers of Comprehensive Workplace Health
2 key elements essential to successfully implementing and sustaining actions that support all 4 elements of comprehensive workplace health
1. Leadership Creating and facilitating an environment in which all employees can work together towards
optimal employee health and organizational performance Should occur at all levels
2. Employee Engagement Satisfaction: The level of contentment or passion a person associates with his or her
job/position and the organization Commitment: Inspiration to do one’s best work; to perform at levels beyond what is
expected, while making a meaningful commitment to improving one’s personal health and enhancing organizational performance
Adapted from Ontario Healthy Workplace Coalition Healthy Workplace Model ,2010
The Stakeholder Outcomes They Care About
HR Engagement, Health costs
Finance Positive ROI, Profitability
Occupational Health Employee health, Absenteeism
Operations Productivity & Performance
Sales/Marketing/Customer Service Sales, Customer satisfaction / loyalty
Executive Profitability, Attraction/retention, CSR
(enhanced reputation)
Labour Member satisfaction, health & well-being
Each employee Health/well-being, Stress
Government Population health, Labour productivity
healthcare cost trend
Community Contribution to community benefit;
improved community well-being
Healthy Workplace – Who Cares?
Healthy Workplace Outcomes Measurement- Guiding Principles
1. Understand your organization’s key issues & cost drivers that impact employee health/well-being Determine key benchmark measures & establish baseline
2. Include qualitative measures (e.g. how employees say they manage their health) as well as quantitative
3. Consider both lagging and leading indicators
4. Determine desired objectives/outcomes; establish linkages between outcomes where possible at outset & factor into evaluation methodology
5. Evaluate at identified milestones on an ongoing basis
6. Standardize and align data requirements across all relevant vendors where possible
7. Compare where possible to relevant norms – Canadian, industry specific, etc.
8. Link to external best practice standards such as BNQ¹/GP2S, NQI, etc.
BNQ¹: Bureau de Normalisation du Québec: BNQ 9700-800 norm: "Healthy Enterprise" Prevention, Promotion and Organizational Practices Contributing to Health in the Workplace
Healthy Workplace Outcomes Measurement - Lagging Indicators of Health
The “economic burden” of illness and injury –defined costs spent on events that have already occurred
Health & drug claims Absenteeism Short/Long Term Disability EAP utilization Accidents Turnover Productivity Profitability
Outcomes Measurement – Leading Indicators of Health (Measuring Risk)
Leading indicators of health are predictive of health issues and therefore predictive of health claims and other issues to come
Physical Activity Obesity Tobacco Use Substance Abuse Stress / Resilience Environmental Quality Access to Health Care Engagement Health management attitudes / habits Presenteeism Customer satisfaction/loyalty
Population Health Trends
Diabetes: Economic burden of Diabetes is currently $12.2bln (2X 2000 level) – projected to rise to $17bln by 2020 – Canadian Diabetes Association 2010
Cancer: Costs are doubling every 2-3 years. The model of cancer care is that of adding-on to existing treatments. Rarely does a new therapy substitute of an older one. In ON, cancer drugs cost $22.9mln; $79.1mln in 2006 – Report Card on Cancer, 2007
Obesity: Employees with BMI>40 vs. recommended weight: Lost workdays per 100 FTE’s - 183 vs. 14 Medical claims costs per 100 FTE’s - $51,091 vs. $7503
- Obesity and Workers Compensation; Arch Intern Med; Apr. 2007
Implications for organizations: How many of you measure the direct impact of diabetes, cancer and obesity on your organization? Do you consider the indirect impact on overall taxes of those costs which are
covered by the public health system? Do you assess cost competitiveness versus other countries where a greater proportion of these costs are borne
by the private sector?
Why Link Workplace Outcomes?
Well-being-Absenteeism link: Actual work time lost for personal reasons increased from 7.4 days per worker in 1997 to 9.7 days in 2006 – Statistics Canada 2007
Engagement-Absenteeism link (1): For every 100 workers, 47 disability days reported for “Very satisfied” workers vs. 129 disability days for “Not at all satisfied” workers – Unhappy on the Job, Health Reports 2006
Engagement-Absenteeism link (2): High-engagement organizations: 6.38 absenteeism days/year per employee; lower engagement organizations: 12.89 days - Best Employers in Canada, Hewitt 2009
Wellness-Sick days link: Dow Chemical - Of those who participated in moderate or intense weight management intervention, the average number of lost work days due to illness decreased from 3.9 days in 2006 to 3.4 days in 2007 - Emory University Rollins School of Public Health, 2009
(More) Why Link Workplace Outcomes?
Engagement - Well-being link: Sr. mgmt. interest in employee well-being is a key driver of engagement; however, less than 10% of employees agree that senior leaders treat employees as vital corporate assets – Global Workforce Study, Towers Watson, 2008
Engagement - CSR link: 53% of employees would take a pay cut to work for an employer with a reputation for caring about employees and the community – Kelly Services survey (7,000 employees), 2009
Wellness-Engagement link: 45% of Americans in small-medium sized companies would stay at their jobs longer because of employer wellness programs; 40% were encouraged to work harder and perform better; 26% missed fewer days of work by participating in wellness - The Principal Financial Group , Well-Being Index, 2009
Health & Safety Culture
Safe & Healthy Work
Environment
Working Relationships
Personal Growth & Aspiration
Workplace Health & Well-Being – an Outcomes Framework
Physical Health• Musculoskeletal
• Energy• Safety performance
Social Health• Trust
• Fairness• Connectedness
Psychological Health
• Stress• Overall health
• Control
Leadership/Manager
Effectiveness
Employee health/
well-being
“Health” Metrics- Absenteeism /
Presenteeism- Attraction /
Retention- Health benefits
cost
Business Metrics- Productivity- Customer
satisfaction / loyalty- Financial
performance
Corporate Social Responsibility
Personal Health/Lifestyle
Resources
Supportive Psychosocial
Work Environment
Health & Safety Process
Physical Work Environment
Employee involvement in
CSR
Awareness/ prevention
Risk identification tools/ targeted
support
Linking drug and disability data -an example of a broader outcomes approach
In a 3-year study of employees with rheumatoid arthritis*, the researchers found that: Higher employee out-of-pocket payments may lead to lower medication
adherence As members’ out-of-pocket costs increased by $20 above the baseline, there was a
35% decrease in the percent of the population filling at least one prescription People who adhered to their medication had fewer incidences and shorter
durations of short-term disability claims For members who did not fill a prescription, STD incidence rate was 36%, compared to
23% for members who filled at least one prescription Members who did not fill a prescription averaged 5 days longer STD duration than
members who did fill a prescription
* Integrated Benefit Institute, Research Insights- “The Blind Man and the Elephant” , 2007
Implications for organizations: plan design and pricing decisions must consider the impact on the full spectrum of programs, taking into account integrated data and metrics; in the above example, the benefits strategy
would logically include promoting medication adherence
34
Workplace Health & Well-being – A Continuum & Planning Framework
Health PromotionHealth Risk
ManagementSelf/Professional
CareCase Management
Opportunities for Integrated Prevention/Care Management Interventions
WellE.g., low risk, good nutrition,
active lifestyle
At Risk E.g., inactivity, high stress,
overweight, high blood pressure, smoker
Catastrophic Conditions
E.g., severe burns, premature infant, head injury
Community-based programs (awareness/prevention)
Targeted health risk assessment Self-care triage tool Utilization management
Immunizations Targeted behavior modification (e.g. health coaching)
Telephonic//E-consults/Clinician visit
Disease-specific Case management
Health Screening-HRA & biometrics
Stress/mental health management Post- decision support Care coordination
Health information resources Community-based programs (risk-specific) Social supportOccupational health and
safety
Acute ConditionsE.g., respiratory, strain and
sprains, lacerations
Behavioral and clinical support
Disease Management
Patient identification and enrollment
Care coordination
Address co-morbid conditions
Chronic ConditionsE.g., prevalent diseases and
chronic conditions
“Preventable illness makes up approximately 70% of the burden of illness and its associated costs. Well executed health promotion programs can show savings of up to 20% in the first year.” - Dr. James Fries, Beyond Health Promotion: Reducing the Need and Demand for Medical Care, 1998
A Word About Chronic Disease
When employees suffer from chronic diseases, organizations can experience lost productivity and lost opportunities, e.g.:
increased employee absenteeism; increased disability; increased accidents; reduced workplace effectiveness; and negative impacts on work quality or customer service¹
Globally, mortality from chronic disease is about 56 percent of all deaths among the working-age population and is the main factor behind lost work time in this group²
Businesses have a vital role in the prevention and management of chronic diseases, and also in helping their employees—who live with chronic conditions—to enjoy a high quality of life, and work productively. This role is critical to individual health and well-being, firm-level success, sector performance and, ultimately, the overall prosperity of Canada³
¹World Economic Forum, Working Towards Wellness: The Business Rationale, (Geneva: World Economic Forum, 2008
² World Economic Forum, Working Towards Wellness: The Business Rationale (Geneva: World Economic Forum, 2008
³ Addressing Chronic Diseases-What’s Business Got to Do With It?, The Conference Board of Canada, Sept. 2010
CWH Implementation Process
Take Stock Take Action Evaluate
1. Take Stock: Monitor, measure, and report data that reflects workplace health and organizational performance
Monitor: Identify & assess key workplace health issues Measure: Gather available data or measure using relevant tool Report: Identify gaps and review results with relevant stakeholders
2. Take Action: Develop a healthy workplace strategy and implement a plan to best address the needs and gaps identified in taking stock phase
Plan: Set goal and identify programs, processes or policies needed; develop action plan Act: Implement action plan
3. Evaluate: Evaluate outcomes and report on effectiveness and impact of the plan Evaluate: Use tools to evaluate process, determine if plan has been fully implemented, and
if goals have been met Revise: Identify what should be continued, stopped, or revised. Start CWH implementation
process over as necessary.
Adapted from ON Healthy Workplace Coalition Healthy Workplace Model 2010 ADD LINK
Generating Outcomes – Emerging Opportunities
Emergence of effective tools to measure costs & identify outcomes opportunities More wellness offerings by mainstream workplace health service providers - but
often not seamlessly linked to core offering (e.g. Life/health carriers – wellness/prevention)
Need greater integration of traditional services (e.g. proactive referral of STD/LTD claimants to EAP)
Need greater integration of new/emerging workplace health/wellness services with each other AND with existing services (e.g. synch HRA and biometric screening initiatives and link results with flex benefits enrollment process)
More emphasis on disease management – new entrants to workplace health market
Employer coalitions
Generating Outcomes – (More) Emerging Opportunities
Employee health/well-being as part of Corp. Social Responsibility (CSR) strategy Workplace health common standards & model
e.g. ON Healthy Workplace Coalition Certification – GP2S, NQI, etc. Multi-stakeholder collaboration – all workplace health stakeholders Measure societal impact of workplace health initiatives (e.g. utilization of public health
resources) Can help to provide the business case for government to consider incentives for workplace
health improvement
Conclusion
The good news: Considerably greater business emphasis on the importance of employee health and well-being
The challenge/opportunity:: Health/well-being to become “way of doing business”; heightened emphasis on evaluation and generating outcomes; health indicators will increasingly be linked to key organizational drivers
Caution: Health/well-being resources, programs & initiatives that do not demonstrably enhance key organizational drivers will become superfluous
Several reports have been published with respect to WHP programs amongst Canadian employers
Initial phase - reviewed existing WHP literature Next – Employer survey to better understand information on WHP initiatives
that are emerging or otherwise not found in literature review This survey and case studies will add to the current body of knowledge by
assessing: What health and wellness metrics are used in program evaluation? How are health metrics related to specific employee productivity metrics? Are WHP programs being developed/modified in response to specific issues
identified through a process to assess employee health issues/needs? What is the ROI of given WHP programs? Do incentives play an important role in employee participation? Are incentives
evolving beyond awareness towards “taking action”
Next Steps- Employer Survey
Survey – a call to action
Selected Canadian employers were initially asked to participate in the survey in Summer 2010
Survey now ready for broader distribution Learning opportunity:
subset aggregate report for HW&W Conference attendees participants will have access to survey results to help inform dialogue on WHP going forward
The survey as well as background and contact information is available at:http://www.biomedcom.org/en/whpstudy/
• you can take more than one session to complete the survey; remember to Save before Logging Out • when you have completed the survey, check Survey Completed, click Save, and then Logout
Program Evaluation: Nearly ¾ of responding employers formally evaluate their programs
health metrics, outcomes – yes ROI – not measured
Incentives: Nearly all employers surveyed provide incentives for participation… …more than ½ provided incentives for TAKING ACTION
Survey – early returns
While at HW&W please visit the Internet Café and complete your survey on the spot!
If you have any questions concerning the WH survey or any aspect of this presentation, please contact Peter or Allan at:
[email protected]@cogeco.ca