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Addressing the Value Proposition of Worksite Health Promotion

IOM Committee on Valuing Community-Based, Non-Clinical Prevention Policies and Wellness Strategies

Nico Pronk, Ph.D.HealthPartners Health Promotion DepartmentHealthPartners Research Foundation

Harvard School of Public Health

December 5, 2011Washington, DC

Questions to be Addressed

• How can worksite health promotion programs optimize the likelihood that employers find value in them?

• How can program design elements be identified and utilized that are informed by evidence of effectiveness?

• What kind of simple methods can be deployed to support implementation practitioners in monitoring program impact (and value)?

Agenda

• Making decisions based on evidence

• Moving beyond limitations of available evidence

• Practice and Research Connected model

• Design for outcomes

• Framework for action

• Practical reality of practitioners

– Simple method for monitoring programs

• Discussion

What Works?

• What is the evidence that shows interventions can– Effectively reduce health risks at the workplace

– Reduce healthcare costs– Increase productivity

– Improve morale

– Optimize employee engagement?

• What are the best practices and essential elements of interventions to reduce health risks?

Recommendations for Assessment of Health Risk with Feedback (AHRF) from the Community Guide

• AHRF includes both health assessments and biometric screenings

• The Task Force finds insufficient evidence to determine the effectiveness of AHRF when implemented alone

• The Task Force recommends the use of assessments of health risks with feedback when combined with health education programs, with or without additional interventions, on the basis of strong evidence of effectiveness in improving one or more health behaviors or conditions in populations of workers

ROI LITERATURE REVIEW

Systematic review and meta-analysis

Conclusion:Worksite health promotion programs can

generate positive ROI for medical- and absenteeism-related savings:

medical: 3.27 : 1absenteeism: 2.73 : 1

Workplace Wellness Programs Reduce Costs

Workplace Wellness as a Strategic Business Imperative

Companies across a variety of industries report benefits:

• Lower health care costs• Greater productivity• Higher morale

ROI can be as high as 6:1

Six Essential Pillars for Successful Programs:1.Engaged leadership at multiple levels2.Strategic alignment with the company’s identity and aspirations3.A design that is broad in scope and high in relevance and quality4.Broad accessibility5.Internal and external partnerships6.Effective communications

Program DesignEssential Elements of Successful Programs

Organizational Culture and Leadership1. Develop a “Human Centered

Culture”2. Demonstrate Leadership3. Engage mid-level managementProgram Design4. Establish clear principles5. Integrate relevant systems6. Eliminate recognized

occupational hazards7. Be consistent8. Promote employee participation9. Tailor programs to the specific

workplace10. Consider incentives and rewards11. Find and use the right tools12. Adjust the program as needed13. Make sure the program lasts14. Ensure confidentiality

Program Implementation and Resources

15. Be willing to start small and scale up

16. Provide adequate resources17. Communicate strategically18. Build accountabilityProgram Evaluation19. Measure and analyze20. Learn from experience

TOTAL WORKER HEALTHTOTAL WORKER HEALTH™™

Moving Beyond Available Evidence

• Evidence of what works needs to be applied in the context of the workplace environment

• Inflexible focus on program fidelity may limit adoption of programs with sustained success

• Practice-based evidence can only be generated if solutions are successfully implemented

• Worksite health promotion programs will only deliver on their promise when supported as a business strategy with leadership support and accountability

• Successful “translation” of available evidence into practical solutions is paramount

● From efficacy research● to effectiveness research● to practical applications

● Research-informed practice

● to evaluation, action research, or participatory research

● to new hypotheses generation● Practice-informed research

Knowledge Translation

EfficacyResearch

EffectivenessResearch

RERE--A

IMA

IM 44--SS

HypothesisGeneration

Observing

SystematicReviews

Standardizing

Presencing

ImplementationProcessCQI, TQM, Six Sigma, PDSA

Research

Practice

PracticePractice--Informed

Informed

Research Path

Research Path

Translation Curve

Reflecting

Summarizing

Sensing

Piloting

Prototyping

Drafting

Action ResearchSpirals

ResearchResearch--Informed

Informed

Practice Path

Practice Path

ParticipatoryResearch

Practice and Research Connected

Translation of research-based learnings into practical solutions

“Translation Curve”

Observing Standardizing

Reflecting

Summarizing

Sensing

Piloting

Prototyping

Presencing

Drafting



Reflecting

Summarizing

Sensing

Piloting

Prototyping

Presencing

Drafting

Seeing “reality” with a new set of eyes. Objectively accessing what is known using tools and techniques that reflect current evidence; not merely gathering information that confirms preexisting assumptions. Being open to absorb available knowledge and information in a non-judgmental way.



Reflecting

Summarizing

Sensing

Piloting

Prototyping

Drafting

Taking stock of what is known about a specific topic in the context of program structure, process, and outcomes. This step includes the identification of knowledge gaps.

Presencing


Presencing


Reflecting

Summarizing

Sensing

Piloting

Prototyping

Drafting

Contemplating and uncovering the meaning of what has been observed. In so doing, uncovering the possibilities and intention of what may need to be done in order to generate a new solution.


Presencing


Reflecting

Summarizing

Sensing

Piloting

Prototyping

Drafting

By considering the potential solution as part of a new mental model or paradigm (rather than reflecting in the context of mental models that are based on past experience), an emerging new purpose, will, and ideas for action are uncovered.



Reflecting

Summarizing

Sensing

Piloting

Prototyping

Drafting

The point at which there is a recognition of what the solution will be like. The vision of what needs to be created presents itself and clarity of purpose initiates the emergence of the new reality. Presencing reflects the point at which the future emerges into the present.

Presencing


Presencing


Reflecting

Summarizing

Sensing

Piloting

Prototyping

Drafting

The first step in building the practical solution as

the team creates the new reality by sharing their

plans, thoughts, and ideas. This step

generates the blueprint for the new application.


Presencing


Reflecting

Summarizing

Sensing

Piloting

Prototyping

Drafting

The first attempt at building the solution so it

can be tested, improved upon, and prepared for

initial market-readiness. Lots of customers and consumer insights are gathered at this stage.


Presencing


Reflecting

Summarizing

Sensing

Piloting

Prototyping

Drafting

Testing of the most promising prototype(s) in a real-world

situation that is highly reflective of the marketplace

in which this practical solution has to perform. This

stage allows for final adjustments to the product

prior to full production.



Reflecting

Summarizing

Sensing

Piloting

Prototyping

Drafting

Full implementation of the new solution in the market according to a newly created or

established method and process that is routinely followed to optimize

performance and reduce variance in outcomes.

Presencing



Reflecting

Summarizing

Sensing

Piloting

Prototyping

Presencing

Drafting

Systematic Reviews

RE-AIM 4-Ss

“Translation Curve” Tools

Practice and Research Connected

1. DESIGN

2. EXPERIENCE

3. HEALTH &PRODUCTIVITY

4. ROI

•Comprehensive•Evidence-informed•Person-centric

•Participation•Satisfaction•Willingness to refer

•Modifiable behavior•Quality of life•Human performance

•Reduced Utilization•Productivity improvement•Cost-effectiveness

“4 Steps of Simple Design”

Possible Simple Socially rewarding

Financially rewarding

Personally relevant

Organizationallyrelevant

Community connected

Individual

Inter-individual

Organizational

EnvironmentalLeve

ls o

f Inf

luen

ce

Make Being Healthy and Productive…

Exceptional Customer and User Experience

Outcomes

Generating Value for Stakeholders

Source: Pronk, NP . Journal of Physical Activity and Health , 2009, 6 (Suppl. 2), S220-S235.

HealthProductivityFinancial / ROI

Practical Reality

• Simple methods are important in day-to-day program implementation and administration

• Focus on most meaningful and impactful factors

– Population definition

– Penetration

– Implementation – Participation

– Effectiveness• Population health impact may be positioned as the

multiplicative result of four distinct impact measures• Impact measures are integrally related—if any one measure

equals zero, total impact equals zero

The PIPE Impact Metric• Penetration

– The proportion of the target population that is reached with invitations to engage in the program or intervention

• Implementation– The degree to which the program has been implemented

according to its work plan

• Participation– The proportion of invited individuals who enroll in the program

according to program enrollment and tracking mechanisms

• Effectiveness– The rate of successful participants

– Success may be defined in multiple ways, e.g., number of individuals meeting a certain standard or threshold, number of steps per day compared to baseline, etc.

Program“Investments”

Program“Returns”

PIPE Impact Metric Example

• Worksite walking program– Population = 10,000 employees

– Penetration: 98% received program invitation

– (9,800/10,000) = 0.98

– Implementation: 85% of work plan successfully implemented

– 85% = 0.85

– Participation: 1,666 employees enroll in the program

– (1,666/9,800) = 0.17

– Effectiveness: 750 employees met success criterion

– (750/1,666) = 0.45

• Program Impact: (0.98)(0.85)(0.17)(0.45) = 0.0637 = 6.37%

Population Health Impact = (Penetration)(Implementation)(Participation)(Effectiveness)

References• Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings.

Health Affairs (Millwood). 2010; 29(2). Published online 14 January 2010.

• Berry LL, Mirabito AM, Baun WB. What’s the hard return on employee wellness programs? Harvard Business Review 2010 (December);88(12):104-112.

• NIOSH Essential Elements List (see http://www.cdc.gov/niosh/TWH/essentials.html).

• Pronk NP . Practice and research connected: A synergistic process of translation through knowledge transfer . In: Pronk NP , Ed. ACSM’s Worksite Health Handbook, 2nd Edition. Human Kinetics, Inc. Champaign, IL, 2009.

• Pronk, NP . Physical activity promotion in business and industry: Evidence, context, and recommendations for a national plan. Journal of Physical Activity and Health, 2009, 6 (Suppl. 2), S220-S235.

• Pronk NP . Designing and evaluating health promotion programs: Simple rules for a complex issue. Disease Management & Health Outcomes 2003;11(3):149-157.

• What works in worksite health promotion. Systematic review findings and recommendations from the Task Force on Community Preventive Services. American Journal of Preventive Medicine 2010 (February);38(2) Suppl 2.

http://www.cdc.gov/niosh/TWH/essentials.html

Thank You!

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