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The Science Behind an Effective
Wellness Programme
Dr Anouska Carter, Sheffield Hallam University
Fiona Lowe - Head of People Strategy, Westfield Health
Today’s session
• The AWRC: the public/private partnership delivering wellness science
• Why do employee wellbeing and activity levels matter?
• The SHUWellness approach to sustained health improvements
• Westfield Health - a case study
The Advanced Wellbeing Research Centre
• A partnership bringing science to the masses and workplaces –innovations that help people move
• Public sector expertise from academia & medicine including: the National Centre for Sport & Exercise Medicine; SHU
• Private sector partners: Westfield Health; Toshiba; Parkrun
• Merging: elite sports science; psychology; sports & materials engineering; software development
• A state of the art incubator based on proven model
Why do employee wellbeing and
activity levels matter?
Dr Anouska Carter, Sheffield Hallam University
Overview
• History
– Preventative medicine
– Workplace health promotion
• The case for lifestyle behaviour change
– Physical Activity
• PA Recommendations
• Why workplace
• Summary
History: Preventative Medicine• Traditionally medicine has focused on ‘finding a
cure’ rather than preventing ill health
• Lifestyle related public health has been on the agenda in the UK, with organisations such as the RCP since as early as 1726
• Due to the huge cost of ill health, modern medicine has started to shift towards improving public health through;– Health promotion
– Prevention of ill health
– Improvements in QoL
Prevention
Cure
History: Workplace Health Promotion
• Occupational health and safety has traditionally focused on protection of workers from hazards
• Workplace health promotion (WHP) has gained increasing support across all sectors due to it’s ability to impact on absenteeism and presenteeism
• WHP initially has been more prominent in the US, due to potential health insurance related savings
• More recently the wider benefits of WHP have been noted across Europe and the UK– In 2012 the European Agency for Safety and Health at Work,
suggested significant cost savings from WHP
– In 2008 Price Water House Cooper reported an average return on investment of £4:£1 spent in the UK
The Case for Lifestyle Behaviour Change
“Most premature deaths are preventable by taking
cost-effective action to tackle four main behavioural
risk factors – tobacco use, harmful use of alcohol,
physical inactivity and unhealthy diet”.
United Nations Development Programme
22%
42%
9%
6%
21%
CardiovascularDisease
Cancer
RespiratiryDisease
Liver Disease
Other
•150,000, premature
deaths in the UK per
year
•2/3 of which are
entirely preventableNHS England
“We’re already spending more on obesity
related health care costs than we are as a nation
on the police, the fire service and the criminal
justice system combined’
‘This is not just a health issue we need to sort
out – this is an economic necessity. We need to
get much more serious as a nation about
prevention and our own health”.
Simon Stevens, Chief Executive, NHS England
Physical Activity
• Physical inactivity increases the risk of many adverse health conditions such as; – coronary heart disease
– type 2 diabetes
– breast and colon cancer
– shortens life expectancy (Lee et al., 2012)
• One third of all deaths are due to diseases which could be at least partly reduced by increased physical activity
(Allender et al., 2007)
• The indirect cost of physical inactivity (excluding obesity) in England is £8.2 billion (Dept. Of Culture Media and Sport, 2002).– Direct cost to NHS is estimated at £1.06 billion
(Allender et al., 2007)
Physical Activity
Public Health Outcomes Framework, 2011-13, Public Health England
Life expectancy at birth (male) in years
Healthy life
expectancy
at birth
(male)
in years
75
70
65
60
55
50
R2=0.69
Richmond-upon-Thames
Wokingham
Blackpool
Tower Hamlets
Barnsley
76 78 80 82
Physical Activity
Public Health Outcomes Framework, 2011-13, Public Health England
Adults who are physically active (%)
45 50 57 60 65 70
75
70
65
60
55
50
R2=0.32
Richmond-upon-Thames
Wokingham
BlackpoolTower Hamlets
Healthy life
expectancy
at birth
(male)
(years)Barnsley
Physical Activity
Public Health Outcomes Framework, 2011-13, Public Health England
Adults who are physically inactive (%)
20 25 30 35
75
70
65
60
55
50
R2=0.35
Wokingham
BlackpoolTower Hamlets
Healthy life
expectancy
at birth
(male)
(years) Barnsley
Richmond-upon-Thames
Physical activity Recommendations for Health?
At least 150 minutes of moderate aerobic activity such
as cycling or fast walking accumulated every week
and strength exercises on two or more days a week
that work all the major muscles
75 minutes of vigorous aerobic activity and strength exercises
on two or more days a week that work all the major muscles
A mix of moderate and vigorous aerobic activity every week
and strength exercises on two or more days a week that work
all the major muscles
Sedentary behaviour independent risk factor
16
Even low amounts of moderate exercise (as little as 15 minutes of walking per day), are associated with improved health and decreased chance of death. More, and more vigorous exercise (up to as much as 90 minutes per day), only improves these measures.
Wen, C., Wai, J., Tsai, M., Yang, Y., Cheng, T., Lee, M., Chan, H., Tsao, C., Tsai, S., & Wu, X. (2011). Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study The Lancet DOI:
10.1016/S0140-6736(11)60749-6
How much physical activity is enough?
Why the Workplace?• Employees spend the majority of their time at work
• If we are to tackle the problem of reducing the burden of
preventable disease it needs a multifaceted approach. The
workplace needs to play it’s part.
“Achieving improved health in the workplace, can help to
significantly reduce demand on stretched NHS services.
But the benefits are not just for the NHS. Healthier staff will
feel better, be more productive, and happier at work. And
employers can save money on sick pay or the costs
associated with high staff turnover.”
Dame Carol Black, Department of Health Expert Advisor on
improving Welfare at Work
Summary
• Shift towards preventative medicine
• Lifestyle behaviours play a significant part in
reducing the economic burden of ill health
• Positive lifestyle behaviour change helps the
individual, organisations and population
• Physical activity plays a significant part in
improving health outcomes
SHUWellness:
Our approach to sustained health
improvements
Dr Anouska Carter, Sheffield Hallam University
Overview
• Business Case for Workforce Health
– Why workforce wellbeing
• Our Solution: The SHUWellness Model
– History
– The SHUWellness experience
– Motivational interviewing
• Evidence Base
– NHS Results
– University Data
Business Case for Workforce
Health
Why Workforce Wellbeing
Cost of absenteeism and presenteeism (6x)
Focus on absence
management can presenteeism
Solution needs to target both
SHUWellnessLifestyle
behaviour change
Improved Health
Increased productivity
ROI ~£1:£4
Presenteeism: 'practice of coming to work despite illness, injury, anxiety,
etc., often resulting in reduced productivity'
Absenteeism: 'being away from work for either uncontrollable factors
like sickness, emergency, accidents etc. or without good reason'
Our Solution:
The SHUWellness Model
History
SHUWellness • 2005-present (n~5000)
STH Pilot • 2012 (n=50)
YHAHSN NHS Pilot • 2013-14 (n=300)
YHAHSN Roll-out
• 2014-16
• Delivery and TTP
• All sectors
Westfield Health
Partnership• 2016 -
The SHUWellness Experience
Client centred wellness
appointment: 1 hour, annual, 1-to-1
Lifestyle workshops
Clinical referral i.e. GP, Physio
Local services i.e. stop smoking
Organisational services i.e. counselling
The SHUWellness Experience:
More than just a health screen:
• Developed by an interdisciplinary team of academics
• 10 years worth of scientific evidence demonstrating significant and maintained health improvements
Evidence Based
• All practitioners are trained in delivering Motivational Interviewing (MI) in a wellness setting
• Client-centred; therefore bespoke to individuals' needs
• Promotes autonomy and develops an individual action plan for change
Promotes Behaviour Change
• Vast depth and breadth of knowledge in MI, providing lifestyle support and taking physiological measures
Skilled Practitioners
• All measures are voluntary and chosen to support lifestyle change and disease prevention
• Point of care testing
• Includes assessment of aerobic capacity (fitness)
Supported by key health indicators
The SHUWellness Experience:
What people say
"I am really pleased that I took
part in the programme as it gave
me the motivation to finally do
something positive.
The information I was given
empowered me to take charge of
my own health.
"This programme really did
motivate me to stop smoking.
Overall I found the programme
really rewarding and the
assessors were great too."
• staff reported making changes to their health or lifestyle
95%
• rated their experience of the programme as excellent or very good
97%
• agreed that the service would be a valuable workplace benefit
98%
What is Motivational Interviewing?
Basic Definition: Motivational interviewing is a collaborative
conversation style for strengthening a person’s own motivation and
commitment to change
(Miller & Rollnick, 2013, p.29)
Technical Definition: A person-centered, goal-directive counselling
method for resolving ambivalence and promoting positive change
by eliciting and strengthening the person’s own motivation for
change
Motivational Interviewing Advice Giving
Collaborative Confrontational
Evocation Educational
Autonomy Authoritative
Explore Explain
Where does MI fit?
Intention to change Behaviour change Improved
physical/mental health
MOTIVATION PROCESS OUTCOME
MI
Bridging the Gap
Why use MI?
• Workplace interventions using MI have the biggest impact on
physical activity and healthy eating outcomes
• MI compared to traditional advice is more successful in improving
BMI, total cholesterol and systolic blood pressure
• 27% higher quit rate in smokers compared to advice giving
• It promotes autonomy, removing reliance on the practitioner
• Saves approximately 100 minutes of treatment time per individual
on average
MI in SHU Wellness
1. Throwaway question(s)
2. Agenda setting (acknowledge questionnaire)
3. Provision of test menu (nothing is compulsory)
4. Developing a focus
5. Summary
6. Welcome back (recheck focus)
7. Health implications of each measure
8. Related lifestyle behaviours
9. SMART goals
10. Barrier exploration
11. Contingency plans (lapse and relapse)
12. Self-monitoring method
13.Social support exploration
14. Next steps
(Physiological testing)
Introduction
Feeding back
report
Action planning
Evidence Base
What do we measure?
Project Engagement
• How many and who
• Gender
• Age
• Site
• Ethnicity
Cardiovascular Health
• Body Measurements
• Blood Pressure
• Resting Heart Rate
• Cholesterol (TC and HDL)
• Blood Glucose
• Lung Function
• Aerobic Capacity (Fitness)
Lifestyle Behaviours
• Mental Health
• Wellbeing
• Perceived Stress
• Resilience
• Physical Activity
• Nutrition
• Alcohol
• Smoking
• Productivity
• Absenteeism
• Presenteeism
Staff Feedback
• Why did you attend?
• What impact has it had?
• Additional Comments
NHS Results
Baseline Health
So did the NHS need it?
• 51% had at least 1 CVD variable in the at risk category
• 32% had at least 2
– 50% had borderline or high cholesterol
– 69% were overweight or obese
– 61% had poor levels of aerobic fitness
NHS Results
Cardiovascular Results
• Reduced CVD risk following a 6-
month SHUWellness programme;
– Blood Pressure (Systolic and
Diastolic)*
– Resting Heart Rate*
– Total Cholesterol*
– BMI and Body Fat (%)*
– Aerobic Capacity
Self-Report
• Improvements in QoL;
– Physical function*
– Vitality*
– Role Emotional*
– Mental Health*
• Improved Diet
– Fruit and vegetable consumption*
• Increased Physical Activity*
* statistically significant
NHS Results
Reduced CVD Risk
and Improved
QoL
Fitter and Healthier
Staff
Improved Absenteeism, Presenteeism
and Turn-Over
Improved Service
Provision
Independent report from YHEC reported an estimate for ROI (based
on absenteeism and presenteeism) from the project of between 302%
and 571%
SHU Data
Results
• The service at SHU improved the cardiovascular health of staff with an 'at-risk'
profile
• These improvements were maintained over 5 years
• Health of those not 'at-risk' was maintained
Conclusions
• The service demonstrates that a university-based wellness service using a
combination of Motivational Interviewing and health screening to elicit behaviour
change was successful in significantly improving and maintaining the health of
employees with an 'at-risk' profile(Flint et al., 2016)
Your subtitle goes here.
How can you implement a wellness programme…to get great engagement rates without it costing the earth?
Fiona Lowe
Head of People Strategy
A little bit about me…
• Head of HR Development and Strategy at Westfield Health
• Fellow of CIPD
• 20 years’ experience
• Experienced in working with Senior Leadership teams to develop
and implement corporate strategy and deliver people strategy
Health: 1. a person's mental or physical condition.2. the state of being free from illness or injury.
Wellbeing: 1. the state of being comfortable, healthy, or happy.
Wellness: 1. the quality or state of being healthy in body and
mind, especially as the result of deliberate effort. 2. an approach to healthcare that emphasises
preventing illness and prolonging life, as opposed to emphasizing treating diseases.
The impact of ill health.
£9bn The annual bill employers face for
sick pay and associated costs.
131mThe number of days lost due to
sickness absence in 2013 costing
the UK economy £100bn
ONS, 2014
A shared responsibility.
80% of UK employers strongly believe that investing in employee
health and wellbeing is good for business.
Westfield Health, 2015
74% of employees agreed that it’s important for health and
wellbeing to be promoted and supported.
How many employers are introducing wellness programmes?
• Talk of wellness strategies used to be something considered ‘fluffy’ – bowls of fruit and
workplace massages, however these strategies are rapidly becoming a vital business tool
to engage and nurture talent.
• Still a degree of scepticism among UK employers about the value of employee wellness;
• More than half of employers will have a defined wellness strategy in place by the end of
2016, spending on employee wellness is up and still growing and more than 75% have
made changes to their working environment to promote healthy behaviour. (REBA, 2016)
• The impetus for wellness strategies that keep employees mentally and physically fit,
healthy and productive will grow even stronger.
• Given the level of time and investment required to properly implement a wide range of
wellness initiatives, its important to measure their effectiveness, whether through
metrics such as participation rates, engagement levels, absence rates and costs,
insurance premiums etc.
Defining your strategy.
What are your current
health & wellbeing
issues?
Consider why you want
to implement a wellness
programme into your
organisation?
What are your health &
wellbeing goals?
Consider budget,
resource and time.
Review and understand
your organisation’s
culture about workforce
wellbeing
Westfield Wellness initiatives.
Development and implementation of health, wellbeing and wellness with our own workforce as we become a health and wellbeing company.
We ensure our culture is embedded with Wellness valuesWe strive to be a Health & Wellbeing exemplar externally, and a role model internally. Take the
Health & Wellbeing of our employees seriously. Understand that people are our most critical resource
1. Developed a Health and Wellbeing Group by involving employees in a programme of events
2. Moving to a champion model and dedication in the area of Health and Wellbeing
3. Implemented management guidance about employee wellbeing
4. Incorporated health and wellbeing into our environment and culture; wellbeing room, on-site gym,
encouraging messages on stairwells etc.
5. Keep talking to employees about what matters to them, and make it relevant and accessible to all
a. Staff surveys e.g. ‘Working carers responsibilities’
b. Aggregated insights from providing staff wellbeing assessments
c. Introduced ‘Employee Huddles’ to improve engagement and communication
d. A dedicated Internal Communication function to communicate to staff
6. Investing in health and wellbeing to move our business to a high performing culture.
7. Targets for health & wellbeing – maintain 2% staff turnover rate and improve absence by 2%
We introduced Walking Lunch.1. Campaign raising the issue of health, wellbeing and wellness in the workplace – 2nd year running.
2. Create a fun and engaging campaign to address the problem of workplace inactivity, our research
indicated that 50% UK employees don’t get up from their desks at all during the working day.
3. Wanted to own something memorable, something which hasn’t been done before, so our campaign
focused on owning and transforming the ‘Working Lunch’
4. Launched ‘Westfield Health Walking Lunch’ during National Walking Month in May
- Created the Footsie 250 challenge; pitted workplaces against each other to walk the most
steps in their lunchbreaks.
- 250 companies and their employees to walk 250 miles
- 2,700 individual and 402 companies took part - comfortably beating our target of 250
- Staggering 72 million steps walked collectively by all teams who entered
5. To support the campaign, we created;
- a shareable video launching the campaign
- research about the inactivity of UK employees (BBC Breakfast)
- celebrity ambassador chosen
- shareable content; blogs, research, infographics, top tips, internal comms
- social media campaign
6. All staff provided with a pedometer to get involved with the competition.
We introduced Wellness Wednesdays.1. Pitched for funding from our Board to set up Wellness Wednesdays
2. Company wide initiative for all staff to get involved.
3. Workshops about our new employee health benefits; Company Doctor and Wellness Programme
4. Sessions to help staff understand their Health Cash Plan, Hospital Treatment Insurance and EAP.
5. Wellness Programme assessments available for all employees; Think Well, Eat Well & Move Well Range with
external providers; approx. 60% staff engagement
- Mental Resilience
- Applied Relaxation
- Backcare
- Know you labels
- Exercising Effectively
6. Fresh fruit deliveries to every floor
7. On-site gym, wellness room and games room for staff.
8. Support National Awareness Days; Time to Talk Day, Move More.
9. Sponsor health and wellbeing research; Carers in the Workplace (with the
CIPD) and share key findings with staff.
10. All members of staff provided with an interactive fitness tracker
