Design Matters:Well-designed Programs Can Generate

Health As Well As Save Money

Nico Pronk, Ph.D., M.A., FACSM, FAWHPHealthPartners Institute

HealthPartners, Inc.Harvard University, T.H. Chan School of Public Health

Agenda

• Whatworksinworksitehealth?– BestPractices– PrinciplesofProgramDesign

• Application– Independently– Retrospectively– Prospectively

• Conclusions

WhatWorksinWorksiteHealth?

• Beinginformedbyevidenceofeffectivenessisuseful

• Moreintentionalfocusonsharingknowledgeinternallyisneeded

Definitionsmatter

• 77%ofemployersintheUSofferedworkplacewellnessprogramsin2013…

• …programsasdefinedby…”atleast1ofthefollowing11services:weightloss,gymmembership,smokingcessation,healthcoaching,classesinnutrition,biometricscreening,web-basedresourcesforhealthfulliving,wellnessnewsletter,flushots,orEAP

• AsreportedinHealthAffairsbytheKaiserFamilyFoundation

WorkplaceWellnessBestPractices

• Workplacewellnessandmedicalcosts,productivity,andperformance

• ACApromotespreventionattheworkplace(CPSTF)• Skepticshighlightpooroutcomes• Confusionaboutvalueofworkplacewellness• Whatbestpracticesareassociatedwithhighlysuccessful

programs?– Reviewofliterature– Categorizedintooverarchingprinciplesofdesign

BestPracticesIdentified…

• 44BestPracticesidentified,e.g.– Commitmenttohealthyculture– Adequateresourcing– Human-centeredculture– Participatorypractices– Programbranding– Analysisandreporting– Wellnesschampionnetwork– Targetedoutreach– Behaviorchangeprograms– Dedicatedstaff– Etc.

9ProgramDesignDimensions

• Designforsuccess1. Leadership2. Relevance3. Partnership4. Comprehensiveness5. Implementation6. Engagement7. Communications8. Data-driven9. Compliance

• Allprinciplesworktogethertocreateacultureofhealthandwell-beingattheworkplace

• Acultureofhealthandwell-beinggivesrisetoahealthy,well,resilient,andproductiveworkforce

9ProgramDesignDimensionsRatingScale

Rating Description

1 Notatallimplemented

2 VeryStronglyDisagree

3 StronglyDisagree

4 Disagree

5 SomewhatDisagree

6 SomewhatAgree

7 Agree

8 StronglyAgree

9 VeryStronglyAgree

10 FullyImplemented

HowdoIratemyorganization?

Leadership

Designelementsthatsetprogramvision,setorganizationalpolicy,ensureresources,supportimplementation,andconnecttheprogramtobusinessgoals.Leadershipshouldbeengagedatmultiplelevelsoftheorganization.

1. Organizationalcommitmenttoahealthyculture2. Programsareconnectedtocompanymission,vision,andbusinessobjectives3. Adequateresourcing4. Strategicplan5. Multi-levelleadershipapproach6. Leadershipisengaged7. Thereisassignedprogramaccountability

Relevance

Designelementsthataddressfactorscriticaltoparticipationandemployeeengagement.Participatoryapproachesshouldbepromoted.

1. Easilyaccessibleprogramoptionswithmultipleprogramdeliverymodalities2. Effectiveprogramoptions3. Tailoredprogrammaticsolutionsforindividuals4. Programssupportself-careandself-management5. Multipleprogramdeliveryoptionsandmodalities6. Familyinvolvementissupported

Partnership

Designelementsthatrelatetoeffortsthatintegratetheprogramwithotherpeopleandentitiesincludingemployees,unions,externalvendorcompanies,communityorganizations,amongothers.

1. Participatorypracticesaredeployed2. Thereisworkerinvolvementandrepresentationindecision-making3. Programisconnectedtocommunity4. Thereisinternalandexternalpartnershipandteamorientation

Comprehensiveness

Designelementsthataddresshealtheducation,supportivesocialandphysicalenvironments,integrationoftheworksiteprogramintotheorganization’sstructure,linkagetorelatedprograms,andworksitescreeningprograms.

1. Supportivephysicalenvironment2. Supportivepsychosocialenvironment3. Clearorganizationalpoliciessupportinghealthandwell-being4. Regularassessmentsofhealthriskswithfeedbackforparticipantsandfollow-up

educationalprogramming5. Organizationalenvironmentalandpolicyassessments6. Integrationofprogramsandvendors7. Awarenessandeducationalprograms8. Behaviorchangeprograms9. Multi-levelprogramming

Implementation

Designelementsthatensureaplanned,coordinatedandfullyexecutedworkplanandprocesstrackingsystem.Actionplanexecutionmatters.

1. Anoperationsworkplanexists2. Animplementationmanagementsystemisinoperations3. Populationtriageandsegmentationtechniquesareused4. Thereistargetedoutreach5. Thereisdedicatedon-sitestaff

Engagement

Designelementsthatpromoteanongoingconnectionbetweenemployeesandtheprogramthroughactionsthatcreaterespect,trust,andanoverallcultureofhealthandwell-being.Experienceasanimportantpredictorforlong-termengagement.

1. Thereisahuman-centeredcultureattheworkplace2. Healthandwell-beingcommitteeexists3. Therearemeaningfulandrelevantparticipationoroutcomesincentives4. Thereisawell-beingchampionsnetwork

Communications

Designelementsthatensureastrategiccommunicationsplanthatgeneratesaday-to-daypresenceoftheprogramintheworkplace.Communicationsshouldbeongoingandengaging.

1. Programbranding2. Year-roundcomprehensiveprogramcommunicationsoccurs3. Marketsegmentationsupportscommunicationsandmessaging4. Tailoredmessagingandcommunications

DataDriven

Designelementsthatensuretheuseofdatainmeasuring,integrating,evaluating,andreportingprogramevolutionandcontinuousimprovementefforts.“Bestdataavailable”approachesshouldbeencouraged.

1. Measurementandevaluationisintentional2. Analysisandreportingisintegrated3. Continuousimprovementisintegrated4. Thereisafocusondatasecurity,dataintegrity,anddataintegration

Compliance

Elementsthatensuretheprogrammeetsregulatoryandethicalrequirementsandprotectsthepersonalinformationofemployeesandparticipants.

1. Businessethics2. HIPAA,GINA,ADA,andotherlegalandregulatoryrequirements

“9 Principles of Program Design”

• Created by HealthPartners• Adopted by American Heart

Association• Applied as a best practice model with

proven, published outcomes:– Indiana University– Slippery Rock University– Turck– HealthPartners (Regions Hospital)

IndependentApplicationExample

• IndianaUniversity– Inyear2,theUniversitysawa15%improvementinriskreduction,100%ofemployeeswouldrecommendtheprogramtoothersandmorethan65%ofemployeesmadeapositivelifestylechange

HoffmanL,Kennedy-Armbruster C.Health&FitnessJ2015;19(3):30-35.

IndependentApplicationExample

• SlipperyRockUniversity– In3yearstime,SRUprogressedfromhavingnocoordinatedprogramtobeingrecognizedasoneofthetop100healthiestemployersintheUS

LynnJS,Urda JL.WorksitehealthInt’l2015;6(2):6-8.

• 10-Yearcasestudyexample• Decreasedbehavioralhealthvisits• Decreasedworkers’compensationandFMLA

claims• Commitmenttocompanypurpose• Giving“besteffort”eachday• Reductioninexternalmedicalvisits;increasein

onsiteclinicandpharmacyuse• <1%turnover(comparedto13%industry

average)• LifeWorks@TURCK isassociatedwith7%to8%

incomefromoperationsinthepast5years• Comparedtohealthplantrend,$4.7Maverted

(2008-2013)

RetrospectiveExample:Turck

Design Principles and Health RisksAssessment Results Across HealthPartners

The higher the Best Practice Program Design Assessment score, the fewer health risks in the population

RegionsHospital

Prospective Example: Regions Hospital

“The big idea was to smart small, listen with intent for expressed needs of people, engage employees from the beginning, and making them the

power behind a healthy, productive and high-performing workplace.”

Discussion

• Makingthe9DimensionsofProgramDesignworkattheorganizationallevel– Gapanalysis– Identifyopportunitiesforimprovement– Allowforlocalvarianceandoptimizerelevance

• Collaborativeprocesstoapplytheselearnings• Intentionalpursuitofbeingabestpracticeorganization

• Beexplicitaboutwhatconstitutesyourprogram!

Thankyou