Wellbeing for Performance - Remedy Healthcare · on the benefit of workplace wellbeing initiatives (see Section 1: About the Study for details). In particular, this project had four

June 2014Report based on data collected at baseline and six month retest

Wellbeing for Performance The benefits of a healthier workforce

A report produced by Towers Watson in collaboration with Australian Unity and its subsidiary Remedy Healthcare.

Towers Watson is a leading global professional services company that helps organisations improve performance through effective people, risk and financial management.

With more than 14,000 associates around the world, we offer consulting, technology and solutions in the areas of benefits, talent management, rewards, and risk and capital management.

About Towers Watson

Australian Unity is a national healthcare, financial services and retirement living organisation providing services to more than 600,000 Australians, including 320,000 members nationwide. Australian Unity’s history is a trusted mutual organisation dating back 174 years. It has grown organically—by continually evolving and providing services and products needed by the communities it serves—as well as through successful strategic mergers and diversification into new business activities.

About Australian Unity

Remedy Healthcare is a wholly owned subsidiary of Australian Unity and is a leading provider of highly targeted, evidence-based self-management programs, health coaching and hospital substitution and avoidance programs. Remedy provides chronic disease management, care coordination, in-home intervention, primary prevention health coaching and maternity support. All programs are based on Australian clinical guidelines, a clinical decision support system, and an advisory panel of medical specialists.

About Remedy Healthcare

Table of ContentsExecutive Summary 3

About the study 3

Key findings 4

Summary 5

Introduction 6

Section 1 : About the Study 8

Measures of health risk, employee wellbeing and productivity 9

Study groups established at baseline 11

Approach, intervention and 6 month retest 13

Section 2 : Analysis & Key Findings 15

Health risk definitions & general trend in health status 15

Effect of intervention 17

Is improved health associated with improved wellbeing, performance and productivity? 27

Section 3: Conclusion 30

This page is intentionally left blank

The benefits of a healthier workforce | Towers Watson| Australian Unity 3

Executive SummaryAbout the studyThe importance of the role of the organisation in supporting the health of employees is becoming globally recognised as an essential factor underpinning performance, productivity and ultimately business success. This collaborative longitudinal research project between Australian Unity, its subsidiary Remedy Healthcare and Towers Watson was designed to contribute robust thought leadership in the field of wellbeing and performance by examining the hypothesis that improved employee health results in improved wellbeing, performance and productivity.

In order to address the above hypothesis a research program was designed comprising:

• Multiple sources of data that were combined at baseline (early in 2013) to provide a comprehensive array of measures considered important to being a healthy, happy and productive employee:

1. An onsite Health Risk Assessment (HRA) that incorporated measures of health (biometric and self-report health risk behaviours) and wellbeing was offered to all employees

2. An all employee engagement survey that included measures of sustainable engagement, self report productivity and cultural factors that support a healthy and productive workplace

3. Payroll data was used to capture more objective measures of performance (end of year manager ratings) and productivity (sick leave occurrences)

• At baseline, the 461 employees that participated in the HRA formed the study group. They were split in to two groups, high health risk and low health risk, based on their responses to the HRA.

• Those at high health risk were eligible for one of three intervention programs designed by Remedy Healthcare to improve their health through a series of tailored coaching sessions over 4-6 months.

• Half of the employees at risk for health were randomly selected to participate in the intervention. They formed the High Risk Intervention group, with the rest making up the High Risk Control group. Those at low health risk formed the Low Risk Control group. Payroll data and employee engagement responses were combined for all other employees that did not participate in the HRA to form a non-study control group.

• The research tracks the health, wellbeing, performance and productivity of the three different study groups (high risk intervention, high and low risk controls) and the non-study control group of employees over time.

• The research also looked at how those who experienced improvements in their health (regardless of study group) compared on job related measures to those whose health stayed the same or worsened.

This report provides an overview of the methodology and results from the data captured at baseline and 6 months later, following the health improvement intervention.

4 Wellbeing for Performance | Report 1

Key FindingsOverall the results show many consistent directional trends in favour of the research hypothesis. Specifically the results show:

• Both the high risk intervention and high risk control groups improved their health over time. The intervention group made lifestyle changes accompanied by encouraging biometric improvements, whereas the control group predominantly made positive lifestyle changes. In addition, the intervention group saw a larger reduction in the number of people with 4 or more risk factors compared with the high risk control group.

• The high health risk employees that participated in a health improvement program showed a much bigger reduction (by 14 percentage points) over 6 months in their risk of developing Type 2 diabetes (as measured by AUSDRISK) than the high risk control group (4 percentage point drop).

• Change readiness appears to be an important factor in making behaviour changes. Compared to both the high and low risk control groups, the high risk intervention group started off with the least amount of people leading a healthy lifestyle or making heath changes. However, at the 6 month retest, the high risk intervention group was the most likely to be making health changes or leading a healthy lifestyle compared to both the high and low risk control groups.

• In the intervention group those who did not complete the retest seem to be in worse health than those in the intervention group who did complete a retest. They are also less willing to change their habits, but intend to in the future.

• The high risk intervention group strengthened their emotional connection to their employer (through a stronger commitment to stay, increased energy at work and employee engagement), and showed an increase in their performance ratings. The improvements seen in the engagement, retention and performance of the high risk intervention group were stronger and more positive than the changes seen in the high risk and low risk control groups.

• Despite improvements seen in performance ratings for the high risk intervention group, self-assessed productivity and sick leave declined across all of the study groups. This was counter to the general trend of improved sense of productivity and absence for the company norm.

• Employees in the low risk control, who had better health, were two times more likely to be rated a high performer by their manager than those in the high risk intervention or control.

• Amongst the study groups, those with low health risk showed the highest levels of personal wellbeing as measured by the Australian Unity Wellbeing Index. Those in the high risk intervention group showed a decline in their personal wellbeing, with the result falling slightly outside the normal range at 6 month retest, likely attributed to a better understanding of their health issues.

• Improvements in health, regardless of study group, are associated with stronger retention, sustainable engagement and personal wellbeing. In particular, those whose health worsened saw a decline in their personal wellbeing, falling outside of the normal range for Australians.


SummaryThis report outlines the results from the baseline and 6 month retest phases (following the health intervention for some high risk employees) of the research project. Findings from the 6 month retest show positive signs in health changes for those who participated in an intervention as well as a few positive changes in job related outcomes. It also shows improved outcomes in terms of, sustainable engagement, retention and personal wellbeing for those who improved their health (regardless of study group) to further support the hypothesis. While there are some positive outcomes, there are also some areas to watch in the further retests.

Based on these results, we see initial evidence in line with other published research that investments in employee health are likely to pay off with improved levels of employee wellbeing, engagement and loyalty. A defined health and productivity strategy that is aligned to business objectives will contribute to sustainable success for a business.

“Investments in employee health are likely to pay off with improved levels of employee wellbeing, engagement and loyalty. A defined health and productivity strategy that is aligned to business objectives will contribute to sustainable success for a business.”


IntroductionAustralian Unity and its subsidiary Remedy Healthcare engaged Towers Watson early in 2013 to partner with them in conducting a longitudinal research project aimed at understanding the relationships between health, wellbeing and individual work performance and productivity. In particular Australian Unity and Remedy Healthcare wanted to develop more robust evidence to test the validity of the following hypothesis:

The importance of establishing a healthy workplace culture as a top priority is becoming globally recognised as an essential factor driving business success. Towers Watson’s recent Global Staying@Work research highlights those companies that get it right by effectively linking the health, wellbeing and workforce effectiveness strategy to the employee value proposition get the most out of their investment in their health programs. And most importantly this research showed that the companies with the most effective health and productivity programs compared to their less effective peers report better human capital and financial outcomes through lower health risks and costs, fewer days of unplanned absence and ultimately higher market premiums (Tobin’s Q) and productivity (measured by revenues per employee).1

While there is a body of research available that highlights how health links to wellbeing and performance and productivity, many of them have their methodological limitations or do not involve following a group of employees pre and post an intervention. This project was designed to overcome the methodological limitations of existing research and contribute to robust evidence on the benefit of workplace wellbeing initiatives (see Section 1: About the Study for details).

In particular, this project had four stated goals and objectives:

1. To discover and assess any link between employee health, wellbeing, performance and productivity

2. To examine the effectiveness of Remedy programs in a corporate setting.

3. To increase the health and performance of Australian Unity employees

4. To strengthen the Australian Unity employee value proposition by providing evidence that links their strategic wellbeing ambition to the employee experience, particularly for those with high health risks

Hypothesis: Increasing employee health is associated with improved employee wellbeing, performance and productivity.

Companies with a highly effective health & productivity strategy reap significant financial rewards for their investment compared to low effectiveness companies.

They are 40% more likely to report stronger financial performance than low effectiveness companies.

An independent external review of BHCS2 documented a return on investment of $2.44 for every dollar they spent on wellness programs.

1 Towers Watson, The Business Value of a Healthy Workforce, 2013/2014 Staying@Work Survey Report.

2 Baylor Health Care Systems (BHCS’s) proactive and comprehensive employee wellness program has earned recognition as a highly effective health and productivity organisation out of America.


This project and its goals were designed to support Australian Unity in making a significant contribution towards its vision to enable millions to enjoy wellbeing. The project offered all Australian Unity employees the opportunity to contribute to this thought leadership. The investment in this wellbeing initiative will help Australian Unity and Remedy Healthcare contribute meaningfully to the global knowledge and debate on wellbeing.

Towers Watson’s global team of subject matter experts worked with Australian Unity and Remedy Healthcare to review and refine the proposed research methodology, including both the research design and measures, to ensure it was well set-up to achieve the project goals and objectives. Towers Watson also utilised its research expertise to match multiple datasets within and across measurement points and to analyse the integrated datasets with the above hypothesis in mind.

This study makes an important contribution to the existing literature by tracking different groups of employees from the organisation over time and combining a comprehensive array of well validated self-report and objective measures of:

• health and wellbeing (both biometric and self-report modifiable health behaviours)

• organisational cultural context (e.g., leadership support, systems & processes, living values)

• employee engagement and retention outcomes (sustainable engagement, retention)

• employee performance (end of year manager ratings) and productivity measures (self-report productivity and payroll absence data).

This first research report presents the results of the data collected at baseline and six months after the Remedy Healthcare intervention began. The report is divided into the following three main sections:

1. An overview of the research methodology

2. A summary of the analysis conducted and the key results

3. Conclusion


Section 1: About the Study

PHASE 1

BASELINEPHASE 2 & 3

REMEDY INTERVENTION

PHASE 4,5 & 6

RETESTS

27 May 2013–1 July 2013 18 July 2013–31 March 2014 10 February 2014–8 March 2014

All employees are offered a Health Risk Assessment (HRA)

Those who chose to participate make up the STUDY GROUP

High Risk Intervention (HRI)

High Risk Control (HRC)

Low Risk Control (LRC)

Those who did not participate make up the NON-STUDY GROUP

Randomly selected HRI employees are offered tailored health coaching.

HRC employees may receive GP referal, and access to employee wellbeing program.

LRC employees receive access to employee wellbeing program.

Non-study group employees receive access to employee wellbeing program.

Examine payroll productivity measures.

NO

N-S

TUD

Y G

RO

UP

NO

N-S

TUD

Y G

RO

UP

Retests are held at 6, 12 and 24 month intervals.

Retests offered to members of three study groups.

Offered to all baseline participants.

The research methodology involves a longitudinal project that, over approximately a three-year period, tracks multiple measures for four different groups of employees from Australian Unity (three study groups (according to high or low health risk) and one non-study control group or company norm). The data is used to examine whether improving employees health also results in improved employee wellbeing, performance and productivity. A random selection of employees at high health risk were offered the opportunity to participate in a health coaching program designed by Remedy to improve their health. In this section of the report the different measures, study participants and approach taken is described.

A high level overview of the key elements of the research methodology is shown in the below graphic.

NO

N-S

TUD

Y G

RO

UP


Measures of Health Risk, Employee Wellbeing, Performance and ProductivityThree sources of data were collected and combined for the study (Figures 1 and 2) at baseline and again 6 months following the start of the Remedy intervention:

1. Payroll data

• Capturing performance and productivity measures such as end of year manager performance ratings and sick leave.

2. An all employee Our People Survey (OPS)

• Data from the 2013 OPS (administered 11 Feb - 1 March 2013) measured leadership, aspects of culture and key employee outcomes. The OPS data was used to formulate the three components of sustainable engagement, retention, self-reported productivity and elements of leadership & culture that support a healthy and productive culture in the workplace.

• Responses from the 2014 OPS (administered 11 Mar – 28 Mar 2014) were used for a company norm group (or non-study control group) in the 6 month retest period.

3. Onsite Health Risk Assessment (HRA)

• The HRA gathered information on health status and medical conditions, health risk behaviours, overall wellbeing and biometric health measures by an onsite, independent nurse.

Figure 1. Data sources available per study group

High Risk Intervention

High Risk Control

Low Risk Control

Company Norm

Payroll Data a a a a

Our People Survey a a a a

Health Risk Assessment a a a


Figure 2. Health, wellbeing, performance and productivity measures

Health Wellbeing Performance Key elements of the workplace Experience

Productivity

AUSDRISK Australian Unity Wellbeing Index

Manager rated job performance (payroll)

Sustainable Engagement and its subcomponents:

• Engaged • Energised • Enabled

Payroll Sick leave – total days

Biometrics1 Retention – intention to stay

Payroll Sick leave – average days per occurence

Change readiness Other factors supporting a healthy and productive workplace7

Self-reported productivity6

Modifiable health behaviours2

Overall health status3

Self-reported medical conditions4

Perceived intervention effectiveness5

1 Blood pressure, cholesterol, glucose, height, waist circumference, weight, BMI2 Alcohol intake, amount of sleep, sleep effectiveness, smoker status, cigarettes per day, fat intake, fruit and vegetable intake, optimism about the

next 6 months, pain, physical activity, stress3 Wellbeing was measured using the Australian Unity Wellbeing Index (http://www.australianunity.com.au/about-us/wellbeing/auwbi) 4 Anxiety, arthritis, asthma/bronchitis/emphysema, back/spinal problems, cancer, depression/bipolar, diabetes Type 1 or 2, family history of

diabetes, heart condition, high blood glucose, high blood pressure, high cholesterol, migraines, other serious conditions, sinusitis/hay fever, stroke5 Applicable only for high risk intervention group6 Using three well validated questions from the HPQ world health organisation7 Leadership support, effective systems & process, goal alignment, living organisation values, ability to challenge traditions


Figure 3. Intervention program eligibility criteria

Intervention Program Criteria

Diabetes Action Self-reported Type 2 diabetes

Healthy Heart Self-reported heart condition

Risk Factor Management AUSDRISK 12+ or RFM 3+ or (Glucose >6.5 and Cholesterol >5.5)

Study Groups Established at BaselineAustralian Unity invited all their employees to participate in the baseline health risk assessment. However, contractors and any employees that had already completed a Remedy Healthcare program were excluded from the study. In total, Australian Unity provided data on 1,838 employees; 513 completed the HRA in the baseline and Australian Unity provided administrative data and OPS responses on the additional 1,325 employees. Of those who completed the HRA, 52 were not eligible and were excluded from the study. This left a study group of 461, who were invited to retest 6 months later.

The remaining 1,325 employees formed a non-study control group used as a company norm. A comparison between this population and the study groups enables stronger conclusions about the effect of the interventions, by controlling for participation bias and other effects outside the study (e.g. the implementation of organisation wide initiatives that lead to performance & productivity improvements).

Following completion of baseline HRAs, the study participants were initially allocated to four groups:

1. High Risk – Eligible for Risk Factor Management Remedy Healthcare Program

2. High Risk – Eligible for Healthy Heart Remedy Healthcare Program

3. High Risk – Eligible for Diabetes Action Remedy Healthcare Program

4. Low Risk – Not eligible for a Remedy Healthcare Program

A scoring system was used to ensure participants would only be selected for inclusion in one of the three Remedy Healthcare programs if they showed up as being eligible for more than one of the three programs. Figure 3 below summarises the eligibility criteria for each of the Remedy intervention programs, which are described in more detail below.


• If an employee had reported Type 2 diabetes they were considered eligible for the Diabetes Action Program.

• If they did not have Type 2 diabetes but had a heart condition they were considered eligible for the Healthy Heart Program.

• A combination of criteria was used to classify employees as eligible for the Risk Factor Management Program.

– Employees were first categorised as high risk and eligible for the Risk Factor Management Program if they scored 12 or more on AUSDRISK or scored 3 or more on a Remedy Healthcare created Risk Factor Management (RFM) score.

– AUSDRISK is an Australian validated index ranging from 0 to 38. It assesses the risk of developing Type 2 diabetes in the next 5 years and incorporates demographic factors such as age, gender and ethnicity but also modifiable factors such as diet, exercise and waist measurement.

– While AUSDRISK is well validated, it is specifically used for determining the risk of developing type 2 diabetes and doesn’t factor in broader health measures that impact a person’s health. As such, a supplemental risk score (RFM) was developed for the study which excluded demographics and instead factored in relevant health risks that can be addressed through coaching, such as stress, sleep and additional self-reported medical conditions and biometrics. This index included the variables listed below, which had scores of 0 to 2, with the exception of family history of diabetes that ranged from 0 to 1. The RFM score was only used to categorise participants as high risk in the baseline and was not used to assess overall health risk in the following analysis section.

The lists below show the specific variables used in the RFM score.

Self-reported health conditions:

Family history of diabetes, high blood pressure, high cholesterol, high glucose, stroke

Health Behaviours: Alcohol intake, amount of sleep, fat intake, fruit and vegetable intake, optimism, physical activity, sleep effectiveness, smoker status, stress

Biometrics: Cholesterol, glucose, blood pressure, waist measurement

• Finally, if a respondent was not originally classified as high risk according to the above criteria but had a blood glucose level of greater than 6.5 and a blood cholesterol reading of greater than 5.5, they were also considered eligible for the Risk Factor Management Program.


Towers Watson then randomly selected 50% of those considered high risk and eligible for one of the three intervention programs to be contacted by a Remedy consultant and offered the program. Once contacted by Remedy, participants could be moved to a more suitable program depending on their specific health conditions. The remaining 50% formed the high risk control group. Additionally, a portion of the employees in the high risk control were randomly selected as part of a back-up list should other selected employees decline an intervention program. A total of 86 employees declined the intervention and were replaced by members of the high risk control. To maximise numbers in the study, the employees who declined participation in a program were kept in the high risk control group and were offered the HRA at the retest six months later.

Following the classification at baseline the project comprised three main study groups and a non-study control group used as the company norm:

1. High Risk Intervention group – n=131

2. High Risk Control – n=225

3. Low Risk Control – n=105

4. Company Norm (all other employees, Non-study control) – n=1,325

Most of the high risk intervention group was made up of the Risk Factor Management Program. Consequently, the sample sizes of the Healthy Heart and Diabetes Action programs prevent intervention specific analysis.

Approach, Intervention and 6 Month RetestAll employees who completed the HRA were given a Personal Health Evaluation Booklet. This booklet included:

• Background information about the research project, including purpose and an upfront section to ensure that employees provided their informed consent to participate voluntarily in the project. It highlighted that their information would be kept confidential and would only be seen by Towers Watson project team members for analysis and Remedy Healthcare consultants for the purpose of coaching, where an intervention is offered. Only de-identified summary results would be shared with their employer

• Tips and national guidelines regarding healthy levels of physical activity, blood pressure and cholesterol, healthy consumption of fruit and vegetables, alcohol, healthy BMI and waist circumferences and the benefits of not smoking

• The Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK)

• Information about the Australian Unity Wellbeing Index

• A reminder about the new wellbeing benefits they can access via their employment

• A reminder that they are ultimately responsible for their own health and wellbeing

• A referral to a medical practitioner should any health indicators be outside the normal standards for further investigation as appropriate.

The referral to a general practitioner for any high risk factors was put in place to ensure the employer’s duty of care was upheld and that no employee was exposed to unnecessary high risk as a result of the study. While this process was ethically important, it is worth noting that this also is likely to reduce differences between different study groups regardless of offering an intervention. It is quite possible that the act of assessing health and raising awareness of health status could motivate participants to change their health habits.


Given the vision of Australian Unity is centred on improving wellbeing; the organisation is very focused on the health of its employees. It has a number of benefits that are health focused for all employees to take advantage of (e.g., reduced private health insurance cost, personal wellbeing plan and objective for every employee). This is also likely to minimise the difference you might expect to otherwise see in the control groups in comparison to a typical situation.

All three interventions, Healthy Heart, Diabetes Action and Risk Factor Management are based on a personalised telephone coaching methodology, designed to take between 4 and 6 months. Once people are enrolled in the program, they receive a phone call every three to four weeks to provide support and personalised advice on how to manage their health risk factors. Each phone call is conducted by an experienced Remedy clinician/health coach and is approximately 30 minutes long, depending on the participant’s needs. These sessions are designed to promote long term self-management of health conditions by helping the individual make small but achievable adjustments to their health behaviours. They are not designed to replace, but rather complement, the role of a GP or medical specialist.

The Remedy intervention began on a rolling timescale after the baseline HRA and was conducted between 18 July and 31 March 2014. Randomly selected individuals were contacted over the phone and offered the opportunity to participate in a program. As part of the initial screening call they were reassessed to ensure they were offered the best program to meet their needs and then the coaching sessions were scheduled. Throughout this time Remedy captured key information about which program they ended up participating in and the number of sessions each participant completed.

The 6 month re-measurement began after the majority of the intervention program was completed with data being gathered between 10 Feb and 8 March 2014.

• All baseline participants were invited to complete a repeat onsite HRA during this time. This allowed for progress and changes to be tracked across all study participants on key health measures (biometrics and lifestyle factors), wellbeing, engagement, retention and self-report productivity measures. Self-reported data on engagement, retention and productivity were collected from the 2013 OPS in the baseline, but were included in the 6 month HRA retest.

• In addition, those that participated in a Remedy program were asked some questions about efficacy of the program and perceived health improvement. It is intended that this retest will be repeated twice more, at 12 months and 24 months from the beginning of the intervention time period.

• While 461 employees in the study group completed the HRA in the baseline, only 237 did so in the 6 month retest period (51% of baseline participants). The shaded row in Figure 4 shows the specific study group sample sizes. These 237 will be the main group examined in this report, however, the differences between those who retested and the 224 who did not will also be examined. It is valuable to know why some participants did not retest and if they have key traits different from those who retested. Of the high risk study groups, more employees in the high risk intervention group (56%) chose to attend the 6 month HRA retest compared with the high risk control group (43%).

Figure 4. Baseline and retest survey completions

High Risk Intervention

High Risk Control

Low Risk Control

Study Group Total

Company Norm

Baseline 131 225 105 461 1,325

Did not retest 58 129 37 224 200

Baseline and 6 month HRA respondents

73 96 68 237 1,125


This section presents the results of analyses conducted to examine the research hypothesis that improved employee health results in improved wellbeing, performance and productivity. These analyses address the below four key questions:

1. Did the health of the high risk intervention group improve over the six month period and how did their health change in comparison to the control groups?

2. Did the intervention and anticipated health changes have an impact on wellbeing, job performance and productivity?

3. Regardless of study group, how did those who experienced an improvement in their health compare on job related measures to those whose health stayed the same or worsened?

4. How do those who did not participate in the 6 month retest differ to those that did participate in retest?

Health Risk Definitions & general trend in health statusIn order to assess an overall health status, 11 health risks were identified, beyond AUSDRISK, on the basis of the health risk assessment and biometric screenings. AUSDRISK is effective in assessing risk of developing Type 2 diabetes, but there are other important factors beyond diabetes. The health risks identified here focus on modifiable health risks rather than age, gender and ethnicity. Modifiable health risks are also more appropriate when looking at the effects of a wellness program, which can only directly influence attitudes and behaviours.

To distinguish between modifiable and non-modifiable health risks, health outcomes (e.g., self-reported health status, absence from work, medical problems) were excluded from the health risk index. The study sample included biometric measures collected during worksite health screenings, but certain biometric outcomes, including blood pressure, cholesterol and glucose, were supplemented with self-reported responses from the HRA.

Individuals were classified into an “at-risk” status for each of the 11 modifiable health risks shown in Figure 5. These dichotomous health risk variables were summed to yield the total number of at-risk health areas. Change in number of health risks from the baseline to the 6-month period served as the primary measure of change in “at-risk” status. To enable descriptive comparisons with previously published research, these dichotomous at-risk measures were also grouped into categories of 0 to 1, 2 to 3, and 4 or more risks (Figure 6). These three categories reflected employees with a low, medium and high number of risks.

Section 2: Analysis & Key Findings


Figure 5. Health risk definitions

Health Risk Area At Risk Criteria

Alcohol1 Men: >14 drinks/weekWomen: >7 drinks/week

Blood Pressure1 Systolic: ≥139 or diastolic: ≥89 or self-report of high blood pressure

Cholesterol2 ≥5.5 mmol/l (random test) or self-report of high cholesterol

Diet1 Eat less than 2 fruit or vegetable servings a day and eat as many or more high fat foods as low fat foods

Glucose2 >6.5 mmol/l (random test) or self-report of high blood glucose of Type 2 diabetes

Mental Health1 Moderately or very concerned about next 6 months and feel troubled by stress a moderate amount of time, almost always or all the time

Chronic Pain Severe or very severe pain in last 3 months or self-report of migraines or back/spinal pain

Physical Activity1 Avoid exertion whenever possible or light exercise for less than 30 mins/day

Sleep3 7 hours of sleep or less and wake up rather unrefreshed but able to function or completely exhausted

Tobacco1 Smoke tobacco/cigarettes currently

Weight1 BMI ≥30 kg/m2 or BMI ≥25 kg/m2 and waist circumference >102cm for men and >88cm for women

1 Nyce et al 2012 JOEM2 Australian Standards referred to by Springboard3 Amount of sleep: Division of Sleep Medicine at Harvard Medical School, study from University of Pennsylvania and Sleep Foundation

Overall, employees in the study group (the high risk intervention, high risk control and low risk control groups) improved their risk status (Figure 6). At the 6 month retest, the percentage at low risk had increased and the percentage at medium or high risk had decreased. The medium and high risk categories saw large decreases in risk status, with 51% and 66% respectively of these groups showing a decrease in the number of risks, while about a third of the low risk group increased their overall number of risks. At the aggregate level (without differentiating results for the different study groups), there was a general trend of improvement in health risk status.

“Two-thirds of those at high risk showed decreases in their number of risks at 6 month re-test.”

Figure 6. Prevalence of risk categories and change of risk status at retest for the study group (i.e., the high risk intervention, high risk control and low risk control groups combined)

Risk Group Percentage at Risk in baseline

Percentage at Risk in 6-month

Risk Increased

Risk Maintained

Risk Decreased

Low (0-1 risks) 48% 53% 37% 42% 21%

Medium (2-3 risks)

37% 34% 23% 26% 51%

High (4+ risks) 15% 13% 20% 14% 66%


Figure 7. Prevalence of risk categories for study groups1

High Risk Intervention High Risk Control Low Risk Control

Percentage at risk in Baseline

Percentage at risk in 6

months



months



months

Low (0-1 risks) 32% 40% 29% 44% 93% 81%

Medium (2-3 risks)

47% 44% 51% 38% 7% 19%

High (4+ risks) 22% 16% 20% 19% 0% 0%

Figure 8. Average risks of study groups

0.0

0.5

1.0

1.5

2.0

2.5Six months

Baseline

Low Risk ControlHigh Risk ControlHigh Risk Intervention

Aver

age

Ris

ks

2.38

2.12

2.42

2.07

0.630.82

Baseline 6 months

Effect of interventionPhysical HealthOne of the primary goals of the intervention programs was to improve the health of participants. As evidenced in the increase in those at low risk, the intervention group did improve their health overall. However, the high risk control saw similar change as well. Figure 7 shows the movement of people in the three study groups through different risk categories. Both the intervention and the high risk control groups lowered their overall risks while the low risk control increased their risk status, with more employees falling into the medium risk category (2-3 risks) at retest. Evidence for the positive impact of the intervention is indicated by a larger reduction in the number of people with 4 or more risk factors in the high risk intervention group (from 22% to 16%) compared with the high risk control group (from 20% to 19%).

Analysis of the average number of risks (ranging from 0 to 11) showed the high risk groups both improved their overall health (Figure 8), whereas the low risk control group saw a slight deterioration in their overall health.

1 This approach was adopted for the purpose of analysis and differs somewhat from the factors that were initially used to classify people in to high and low risk groupings based on their suitability for the Remedy intervention. The measure used to identify study groups was broad with a relatively conservative cut-off to capture as many people with poor health as possible (even if it was only one risk factor showing up as very high risk). This meant that there were no people in the low risk control group at baseline with 4+ risks and only a few with 2-3 risks (see figure 7). While there were a few people in the high risk intervention or high risk control groups that were showing up as “at-risk” for one of the 11 modifiable risks considered in the analysis, this risk was deemed serious enough in the first pass through of data to allocate them to the High Risk Intervention or High Risk Control groups.

Note: Risk score can range from 0-11.


Figure 9. Biometric health risk improvements of high risk intervention, high risk and low risk control groups


At risk for: Baseline 6 mths PPS Change

Baseline 6 mths PPS Change


Glucose 23% 18% -5 18% 18% 0 6% 3% -3

Weight 33% 30% -3 30% 24% -6 1% 1% 0

Blood Pressure 34% 32% -2 32% 29% -3 3% 9% +6

Cholesterol 37% 41% +4 23% 38% +15 3% 15% +12

The reduction of risk in the intervention group was driven by a few key areas, including blood glucose, exercise, chronic pain and diet (Figures 9 and 10). Additionally, the intervention group lost weight and saw a 4 percentage point decrease in obesity over the 6 month period (as assessed by change in proportion classified as obese based on BMI). The decrease in glucose is encouraging as it shows the changes in health behaviours made by the intervention group are having measurable effects on their biometrics. In total, the intervention group made several lifestyle changes accompanied by encouraging biometric improvements.

The improvements of the high risk control group were focused more in the lifestyle risks, as opposed to the biometric factors which were mostly self-reported variables. These changes are promising, but further retests will show if these changes are sustainable and if they will ultimately translate into better biometrics as well.

Conversely, the risk status among the low risk control group eroded, particularly in the biometrics risks. The percentage of the low risk control group at risk for cholesterol, blood pressure, mental health and alcohol increased, showing an uptick in bad health habits.

These results indicate that communication of health status could be a motivating factor in health behaviour change. The high risk control group received a similar message to the high risk intervention group at the baseline and made similar strides in health outcomes. Additionally, the low risk group did not receive a negative message and developed some bad habits over the 6 month period. The act of assessing health and raising awareness and knowledge alone is a catalyst for positive change. This is a testament to the benefits of providing a health risk assessment for employees. The 12 month retest will be important in understanding whether sustainable change is more prevalent with the intervention group.

Two concerning trends identified in the results at this point are the increases in those at risk for cholesterol and mental health. All three study groups, including the low risk control group, saw increases in these areas. It will be beneficial to monitor whether these trends are sustained and identify potential causes, which may then reflect broader contextual factors.

“The act of assessing health and raising awareness and knowledge alone is a catalyst for positive change. This is a testament to the benefits of providing a health risk assessment for employees.”

(See figure 5 for at risk definitions)


Figure 10. Lifestyle health risk improvements of high risk intervention, high risk and low risk control groups


At risk for: Baseline 6 mths Change Baseline 6 mths Change Baseline 6 mths Change

Physical Activity 34% 19% -15 44% 26% -18 6% 1% -5

Chronic Pain 22% 14% -8 24% 16% -8 24% 21% -3

Diet 14% 11% -3 17% 11% -6 3% 1% -2

Smoke 10% 8% -2 13% 8% -5 0% 3% +3

Alcohol 7% 7% 0 16% 10% -6 4% 9% +5

Sleep 12% 15% +3 13% 13% 0 6% 7% +1

Mental Health 12% 18% +6 14% 15% +1 7% 12% +5

With the exception of sleep, mental health and diet, the risk categories this study utilises are dichotomous variables separating those at high risk from everyone else. This classification does not show improvements from medium to low risks. The intervention group saw shifts from medium to low risk categories in a few areas that were not shown in the above results. Specifically, alcohol consumption, blood pressure and physical activity saw improvements including:

• the medium risk category for alcohol dropped 8 percentage points (compared to a 4 ppt drop for high risk controls and 3 ppt increase for low risk controls)

• blood pressure dropped by 11 percentage points in the medium risk range towards a low risk range (with similar magnitude positive trends seen in the high and low risk control groups)

• the low risk category for physical activity (exercising 90 mins or more a week) increased by 15 percentage points (compared to no increase for high risk controls and a 5 ppts increase for low risk controls), showing a positive trend towards healthier activity levels

Those in the medium risk categories are at a pivotal point, they could get better or worse so seeing movement from medium to low risk is encouraging.

Risk of Developing Type 2 Diabetes (AUSDRISK)The approach to assessing “at-risk” status used until now is unique to this study and uses the data available from this specific HRA. Another well validated risk measure in Australia is the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) measure. AUSDRISK is a numerical scoring system ranging from 0 to 38 that measures people’s risk for developing Type 2 diabetes within the next 5 years. A score of less than 5 is considered low risk while scores of 6-11 or 12 or more are considered intermediate and high risk respectively. AUSDRISK scores were calculated by the onsite nurse during the HRA.

The AUSDRISK was not included in this study’s at risk criteria and analysis because of the significant overlap of health outcomes. It also does not consider chronic pain, sleep effectiveness, alcohol consumption and mental health, which are important factors impacting health, workplace productivity and job performance. However, it is valuable to compare the change in AUSDRISK scores of the study groups over time. In particular to examine changes in the risk of developing Type 2 diabetes, which is a chronic (long-term) and costly disease that is expected to significantly increase in prevalence over the coming years1.


1 For more information see http://www.diabetesaustralia.com.au/PageFiles/937/AUSDRISK%20Web%2014%20July%2010.pdf


Figure 11. AUSDRISK group change by study groups





Low Risk (Risk score <5)

41% 42% +1 36% 42% +8 85% 88% +3

Intermediate Risk (6-11)

33% 45% +12 40% 38% -2 15% 12% -3

High Risk (12+)

26% 12% -14 24% 20% -4 0% 0% 0

As Figure 11 demonstrates, the intervention group led improvement in AUSDRISK, which supports this study’s findings that the wellness program positively impacted health. The intervention group saw a 14 percentage point drop in the number at high risk while the high risk control only saw a 4 percentage point drop. High health risk employees that participated in a health improvement program showed a reduction in their risk of developing type 2 diabetes over the 6 month period.

“High health risk employees that participated in a targeted health improvement program showed a reduction in their risk of developing type 2 diabetes over a 6 month period as measured by the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK).”

“A company can offer a wellness program, but it will only succeed if employees are engaged in their health and willing to make necessary changes.”

Readiness for ChangeA company can offer a wellness program, but it will only succeed if employees are engaged in their health and willing to make necessary changes. The intervention group showed a shift in their attitudes around achieving a healthy lifestyle and now recognise the need and appear more committed to change. Following the 17 percentage point increase in readiness to change from the baseline to the 6 month retest, the intervention group became the most active in changing their health habits and leading a healthy lifestyle (Figure 12). Both control groups were less ready to change their health behaviours in the retest period than in the baseline. Given the improvements of the intervention group, change readiness appears to be a defining factor in making lifestyle changes. The clear improvement in the intervention group also provides evidence of the positive impact a tailored health improvement program can have in helping people to prepare and start to make positive changes towards a healthier lifestyle.


Figure 12. Change readiness of study groups

Baseline 6 months

0

20

40

60

80

100Six months

Baseline


Rea

dine

ss to

cha

nge 68%

85%

74% 73%

85%79%

Already making changes or have a healthy lifestyle

Those that did not retest were more likely to have bad health habits and are less ready to change. A sizeable number of participants in all study groups responded to the baseline survey but did not respond again at the retest (Figure 4). The profile of the people that did not retest differs from those who completed the retest in several key ways. In the intervention group, the people that did not retest are more likely to have bad health habits. The baseline health status of employees who did not retest was worse than the baseline health status of those who did retest in terms of smoking, exercise, weight and diet (Figure 13).

This group is also less willing to change their lifestyle, which may be a factor in their decision not to complete the retest. At baseline, 52% of intervention participants who did not retest were changing their health habits or reported that they already had a healthy lifestyle, compared to 68% of the intervention participants who did complete the retest. However, 48% of the people that did not retest stated they intended to make changes within the next 6 months, indicating some overall awareness of the need to change. These participants will be invited to retest in future phases, so it will be valuable to see if they act on their intentions and bring about better health habits over the longer term or continue to defer action.

Figure 13. Prevalence of selected health risks and change readiness at baseline of intervention group who did not retest compared to intervention group who retested at 6 months

High Risk Intervention – group that did not retest

High Risk Intervention – group that retested

Self-report of health status (Very good or excellent health) 33% 37%

At risk for smoking 19% 10%

At risk for physical activity 50% 34%

At risk for weight 40% 33%

At risk for diet 24% 14%

Change Readiness

Not considering change 0% 4%

Intend to change in next 1-6 months 48% 27%

Already making changes or have healthy lifestyle 52% 68%



Australian Unity Wellbeing IndexThe Australian Unity Wellbeing Index1, a partnership between Australian Unity and Deakin University commenced in 2001. The Personal Wellbeing Index (PWI) offers a simple test for those wanting to measure their wellbeing. It covers seven different domains of wellbeing including satisfaction with health, personal relationships, standard of living and sense of community. Ratings can range from 0 to 10 on the seven separate domains, with 10 being completely satisfied. An overall index is calculated and reflects an individual’s overall personal wellbeing, with the normal range for Australians ranging from 73.9 points to 76.7 points.

The intervention group saw a downwards shift to their overall PWI, with the result sitting slightly below the normal range for Australians (Figure 14). After receiving their health report from the HRA, many may have come to terms with their high risk health situation and their responses to the wellbeing questions may reflect those new perceptions. The low risk control reported the highest levels of wellbeing with their PWI sitting above the normal range for Australians.

Figure 14. Australian Unity Wellbeing Index scores by study group


Baseline 6 mths Change Baseline 6 mths Change Baseline 6 mths Change

Personal Wellbeing Index (PWI)

76.4 73.2 -3.2 75.5 74.8 -0.7 79.1 78.5 -0.6

Standard of Living 7.9 7.7 -0.2 7.8 7.8 0 8.3 8.3 0

Health 7.0 6.9 -0.1 7.0 7.2 +0.2 7.8 7.9 +0.1

Achieving in life 7.1 6.8 -0.3 7.0 7.1 +0.1 7.3 7.2 -0.1

Relationships 7.9 7.6 -0.3 7.6 7.7 +0.1 8.2 7.8 -0.4

Safety 8.6 8.1 -0.5 8.3 8.2 -0.1 8.8 8.8 0

Community Connectedness

7.4 6.9 -0.5 7.6 7.4 -0.2 7.3 7.3 0

Future Security 7.6 7.1 -0.5 7.5 7.3 -0.2 7.7 7.8 +0.1

The results suggest that more positive health is associated with higher overall levels of personal wellbeing as measured by the Australian Unity Wellbeing Index.

1 To read more on the Australian Unity Wellbeing Index go to http://www.australianunity.com.au/about-us/wellbeing/auwbi


Figure 15. Retention of study groups and company norm

Baseline 6 months

0

10

20

30

40

50

60

70

80Six months

Baseline

Norm

LRC

HRCHRI

Ret

entio

n

60%

74% 72% 72%

59%64%

It would take a lot for me to for another employee (agree or tend to agree)


59% 58%

Emotional Connection, Sustainable Engagement, Performance and ProductivityRetention is an important issue for many companies and improving employees’ emotional connection to an organisation can keep them from looking for another employer. The emotional connection of the intervention group strengthened and was associated with a stronger commitment to the organisation. After rising 14 percentage points, 74% of the intervention group responded that “it would take a lot for them to look for another employer”, compared to 72% in the high risk control and 64% in the low risk control, that showed no or small change over the study period (Figure 15). This suggests an investment in the health and wellbeing of employees can pay off in increased retention and commitment.

“Results suggest an investment in the health and wellbeing of employees pays off in increased retention and commitment.”

Ultimately, better health and stronger commitment to an organisation should contribute to stronger sustainable engagement levels and higher job performance ratings. Analysis shows that job performance is slightly associated with health improvements. The intervention group improved their job performance while the high risk control group decreased and the low risk control’s performance remained roughly the same. The job performance gap between the intervention and high risk control rose to 7 percentage points, which is a significant gap (Figure 16).

Additionally, the performance ratings of the low risk control suggest those with low health risks to be the best performers in the company. Outside the impact of this wellness program, these results also support the theory that a healthy employee is a more productive employee. The exceeds/outstanding job performance company norm in the baseline and 6 month periods were 18% and 20% of employees respectively, while those of the low risk control were over double that, at 47% and 48% respectively.

“Those in good health are 2 times more likely to be a high performer.”


Figure 16. Job performance of study groups and company norm

Baseline 6 months

0

10

20

30

40

50Six months

Baseline

Norm

LRCHRCHRI

25%29%

27%22%

47% 48%

Exceeds expectations or outstanding job performance


18%20%

Figure 17. Leadership effectiveness by study groups



My immediate leader provides enough support for me.

4.1 4.5 +0.4 4.2 4.4 +0.2 4.3 4.3 0

Senior leaders are interested in the wellbeing of employees.

3.9 4.0 +0.1 4.0 4.0 0 4.1 3.8 -0.3

Note: Baseline Job Performance data reflects the June 2012 performance cycle and 6 months Job Performance data reflects June 2013 performance cycle.

The efforts of Remedy interventions are indicated to have a slight impact on perception of leadership effectiveness as well. The two items in Figure 17 show the average scores, ranging from 0 to 5, which 5 indicating definite agreement to the question. The intervention group showed the strongest increase in feelings of support from immediate leadership and was the only group to show an increase, although slight, of support from senior leadership. Regardless of the productivity and performance outcomes of the intervention, employees recognise that leadership is investing in their wellbeing.

“These results also support the theory that a healthy employee is a more productive employee.”


Both high risk groups saw an improvement in the three components of sustainable engagement (energised, engaged and enabled), which is a measure of an employee’s connection to their organisation and their willingness and ability to achieve workplace goals. Building from traditional definitions of employee engagement, this new concept developed by Towers Watson, called Sustainable Engagement, adds two new elements, one related to supporting productivity, called enablement, and the second related to promoting employee wellbeing, called energy. The unique combination of these three components predicts nearly double the positive financial returns associated with more traditional engagement formulations.

Figure 18 shows the average raw scores of each component of Sustainable Engagement. The three measures are an aggregate of the scores from a selection of 5 point Likert-type scale questions on employees’ attitudes towards their employer and job. Engagement showed a slight increase for the intervention group. This may indicate the investment made in supporting employees to improve their health is associated with improvements in employees’ engagement with the organisation.

In a world where people are dispersed, sometimes isolated, working longer hours with fewer resources,

engagement will not hold up over time without enablement and energy.

Towers Watson’s Sustainable Engagment Model

Fully charged in three ways...

Engaged

Enabled

Energised

Attachment to the company and willingness

to give extra effort

A work environment that supports productivity

and performance

Individual physical, social and emotional

well-being at work

Figure 18. Change in sustainable engagement of study groups and company norm

High Risk Intervention High Risk Control Low Risk Control Company norm

Baseline 6 mths

Change Baseline 6 mths



Change

Energised 30.7 30.9 +0.2 31.3 31.6 +0.3 32.1 30.9 -1.1 30.9 30.6 -0.3

Engaged 38.4 39.1 +0.7 39.4 39.5 +0.1 38.4 37.3 -1.1 37.9 38.1 +0.2

Enabled 21.2 21.2 0.0 20.5 21.4 +0.9 21.3 21.3 -0.1 20.8 20.7 -0.1

Despite improvements seen in elements of Sustainable Engagement and performance ratings, the trends in both absence and presenteeism data are counter to initial expectations. Total days of sick leave taken and average days per occurrence increased for all study groups, but decreased slightly in the rest of the company norm (Figure 19). Similarly, the rate of presenteeism and days of reported presenteeism increased for all three study groups and decreased slightly in the company norm. These results are opposite to expectations and warrant further investigation as to whether these trends will persist in the future retest periods (Figure 20).


Figure 19. Change in absence days and number of occurrences by study groups


Baseline 6 mths




Change

Sick Leave - Total Days (Annualized)

3.1 4.3 +1.2 3.4 4.3 +0.9 2.6 3.5 +0.9 4.3 3.6 -0.7

Sick Leave - Average Days per occurrence (Annualized)

1.2 1.5 +0.3 1.2 0.9 -0.3 1.3 1.5 +0.2 1.2 0.9 -0.3

Figure 20. Change in presenteeism rate and number of days by study groups


Baseline 6 mths




Change

Reports any presenteeism (Adjusted presenteeism rate > 0)^

16% 30% +14 16% 20% +4 12% 31% +19 10% 9% -1

Presenteeism - Days^^

7.6 12.9 +5.3 7.1 10.6 +3.5 4.8 11.4 +6.6 6.9 5.4 -1.5

^ Note: Adjusted presenteeism draws on the validated HPQ approach and reflects a ratio score of employees’ ratings of their current job performance over the past month to their ratings of their usual job performance over the past year or two. Ratios of <1 reflect workers whose performance is less (productive) than usual. Ratios of >1 reflect workers whose performance is greater (more productive) than usual. Ratios of 1 reflect workers whose performance is on par with their usual levels (equally productive).

^^ The presenteeism ratio can also be converted into a lost days metric to add further insights into the business impact of people performing above

and below par.


Figure 21. Australian Unity Wellbeing Index scores by change in health

Health Improved Health Stayed Same Health Worsened


Personal Wellbeing Index (PWI)

75.7 76.5 +0.8 78.5 76.9 -1.6 76.3 72.1 -4.3

Standard of Living 7.7 7.8 +0.1 8.1 8.1 0 8.3 7.7 -0.6

Health 7.1 7.3 +0.2 7.5 7.5 0 7.2 7.0 -0.2

Achieving in life 7.0 7.3 +0.3 7.3 7.0 -0.3 7.1 6.8 -0.3

Relationships 7.8 7.9 +0.1 8.0 7.8 -0.2 7.8 7.4 -0.4

Safety 8.4 8.4 0 8.7 8.7 0 8.4 7.9 -0.5

Community Connectedness

7.7 7.5 -0.2 7.6 7.1 -0.5 7.0 7.0 0

Future Security 7.4 7.4 0 7.7 7.7 0 7.7 6.9 -0.8

Is improved health associated with improved wellbeing, performance and productivity?Dividing the study population into the intervention group, high risk control and low risk control showed the effects of the intervention program. The results also showed that those with more positive health (in the low risk study group) were more likely to have higher overall levels of wellbeing and were two times more likely to be rated by their manager as a high performer.

All three of the study groups had some employees whose health changed for the better. It is informative to see how changes in health are associated with wellbeing and other job related measures, regardless of study group. Ideally the intervention should provide the best chance for long-term sustainable behaviour change and improved health. In future retests, the expectation is that similar trends will emerge in the intervention group as among those who improved their health, if the programs are working as designed.

In this section, an improvement in health is defined as a decrease in the number of risks at the retest (defined by the 11 risks in Figure 5). Similarly, stable health is an equal amount of risks in the baseline and retest periods and a decline in health is defined as a larger number of risks at the retest. The following analysis shows job related outcomes that vary among the three health change patterns.

Changes to health were considered alongside overall wellbeing as measured by the Australian Unity Wellbeing Index. Changes in health were associated with changes in personal wellbeing in the expected direction. For employees whose health improved, there was a slight upwards shift in personal wellbeing, with levels remaining inside the normal range. On the other hand employees whose health worsened saw was a decline in their personal wellbeing (Figure 21), with levels falling outside the normal range reported for Australians.

“A decline in health was associated with a decline in overall personal wellbeing, as measured by the Australian Unity Wellbeing Index.”


Figure 22. It would take a lot for me to look for another employer by change in health



Agree 66% 69% +3 64% 71% +7 63% 72% +9

Neutral 9% 14% +5 11% 11% 0 15% 9% -6

Disagree 25% 17% -8 26% 18% -8 22% 19% -3

Figure 23. Leadership effectiveness by change in health



My immediate leader provides enough support or me.

4.1 4.5 +0.4 4.2 4.3 +0.1 4.4 4.4 0

Senior leaders are interested in the wellbeing of employees.

3.9 4.0 +0.1 4.0 3.9 -0.1 4.0 3.9 -0.1

Figure 22 shows how changes in health are associated with employee retention (i.e. their self-reported commitment to stay with the company). Results show those who improved their health and whose health stayed the same were more likely to be committed to staying with their employer increasing the proportion of “Agree” and showing large reduction in “Disagree” responses. Improvements were also seen in the commitment to the employer by those whose health worsened. This may reflect employees’ recognition that their employer is investing in them and cares about their wellbeing. As noted earlier the mere fact that the organisation is prepared to invest in a HRA for its employees appears to have a positive impact as illustrated by the improvement in retention regardless of health improvement.

Employees whose health improved also showed an increase in perception of support from immediate leadership (Figure 23) and strengthened their perception slightly of support from senior leadership. Again, these movements show recognition from those who improved their health that their employer may have helped them through this wellbeing initiative.


Sustainable engagement is also related to positive changes in health. Similar to Figure 18, Figure 24 shows the raw scores of the three components of sustainable engagement, according to changes in health. The group whose health improved saw increases in all three components, suggesting better health leads to stronger overall levels of sustainable engagement. Alternatively, the energy and engagement of the remaining two groups eroded and their enablement increased only slightly.

The movement in energised and engaged in the group whose health improved was driven by a few key items. Primarily, the changes in energy are centred on the positive feelings about the workplace and personal achievement. The following are the four main items driving the change in the energy component of sustainable engagement. The improvement in energy is encouraging. These respondents brought about positive changes in their health, which are translating to better feelings towards work and higher energy levels.

• I have the energy I need to do my job well throughout the work day. +0.3

• Over the past month, I felt positive at work most of the time. +0.3

• Over the past month, I felt enthusiastic at work most of the time. +0.2

• My work gives me a sense of personal achievement. +0.2

The change in engagement was driven by two key items. The uptick in those willing to recommend their employer as a good place to work aligns with the retention results in Figure 16. These particular items may, again, reflect employee perceptions that their employer cares for them and is trying to help them.

• I would recommend Australian Unity as a good place to work. +0.3

• Australian Unity inspires me to do my best work. +0.2

Figure 24. Change in sustainable engagement by change in health



Energised 31.1 32.2 +1.1 31.9 30.7 -1.1 31.1 30.4 -0.7

Engaged 38.2 39.2 +1.0 38.9 38.4 -0.5 39.3 38.6 -0.8

Enabled 21.1 21.4 +0.3 21.3 21.4 +0.1 20.6 21.1 +0.6


Section 3: ConclusionLeading companies are aware that health is a business issue and that a healthy workforce means a more productive workforce. Wellness programs are therefore becoming more strategic and more prevalent as employers realise that helping employees take control of their health is critical to promoting an organisation wide culture of health. Australian Unity and Remedy Healthcare have set out to influence this market by creating a program aimed at improving employees’ health and therefore wellbeing, productivity and job performance.

So far the program has improved the overall health of its participants. Several measures, such as blood glucose, diet and chronic pain showed positive changes. The improvement in blood glucose is the most encouraging as it shows measurable results of behaviour changes. Aligned with this finding, the high health risk employees that participated in the targeted health improvement program showed the greatest reduction in their risk of developing Type 2 diabetes (as measured by The Australian Type 2 Diabetes Risk Assessment Tool). The high risk control group also showed similar positive changes as the intervention group, but the improvements were often not as strong and were predominantly in healthy lifestyle factors. This may be the result of outside participation in other wellness programs or help from other medical professionals. The subsequent retests will be important in assessing whether health changes in the intervention group are more sustainable than those in the control group. In addition to making health improvements, the intervention group saw changes in a few job related outcomes. Retention, how much it would take for an employee to look for another employer, improved for the intervention group over both the control groups and the company norm. The intervention group saw a slight improvement in job performance ratings while the ratings of the high risk control eroded and resulted in a wide gap between the two groups. Finally, the intervention group led improvements in employee engagement. These improvements support the hypothesis that increasing employee health and wellbeing increases company productivity.

Looking at only those whose health improved, regardless of study group membership, provides further support for this theory. Those whose health improved saw gains in sustainable engagement and some gains in overall wellbeing, over those whose health stayed the same or worsened. Further strong evidence for the business benefit of a healthy workforce is seen in the finding that low risk employees, who are healthiest, are two times more likely to be rated as a high performer by their manager than those at high health risk.

The similar changes of the high risk intervention and high risk control group need further examination; it may simply be too early in the change process to see large differences. It will also be important to assess whether the strides made in changing health habits stick. Some of these changes, like diet, are hard to maintain and the 12 month retest will be important in understanding whether sustainable change is more aligned with the intervention group.

Results highlight the importance of change readiness in people making healthy lifestyle changes. The intervention group showed a clear shift in their attitudes around achieving a healthy lifestyle, with more recognising the need and being committed to leading a healthy lifestyle 6 months down the track. This shift provides evidence of the positive impact a tailored health improvement program can have in helping people to prepare and start to make positive changes towards a healthier lifestyle. The results highlight the importance of not only offering a wellness program, but fostering an environment that supports employees being engaged in their health and motivated to make necessary changes.

Overall the results at this initial phase show encouraging trends and improvements in line with the research hypotheses. The subsequent retests will be important to further understand the effects of the wellness program in improving health and its impact on productivity and performance.

This page is intentionally left blank

Copyright © 2014. All rights reserved.

Documents

Wellbeing for Performance - Remedy Healthcare · on the benefit of workplace wellbeing initiatives (see Section 1: About the Study for details). In particular, this project had four