Designing Effective Wellness Programs

Bruce Coulter, CPEDepartment of Labor and Industries

My DiscussionWellness/Health Promotion ProgramsChallenges in the Trucking IndustryDesigning the Effective ProgramBusiness PlanIntegrationBenefitsCulture

Workplace Health Promotion in Washington StateCurrent Research Findings

Commercial Truck and Bus SafetyHealth and Wellness Programs for Commercial Drivers

welcoa.org

Why Health Promotion?Reduces costsdirect costs: medical insurance, health care, workers compensation, accidents, absenteeismindirect costs: employee job satisfaction and driver retentionIncreasesMorale, productivity, overall health

Wellness/Health PromotionEmployee Health and Wellness (H&W) programs have been around for the past 30 yearsDriven by:Concern for employeesNeed to control healthcare/workers comp costsDesire to decrease absenteeism, lost productivity

What Are The Issues?Health Risk Factors (characteristics associated with increased rates of disease)Tobacco useObesityLack of physical activityHigh Blood PressurePoor eating habitsUse of alcohol, drugs and other chemical substancesVarious forms of psychological and job stress

CDC435,000 deaths per year365,000 deaths per year

435,000 + 365,000 = 800,000/416 = 1923 4161923/365 = 5.27 per day or 2192 people

Qantas Gripe SheetsP: Left inside main tire almost needs replacement. S: Almost replaced left inside main tire. P: Test flight OK, except auto-land very rough. S: Auto-land not installed on this aircraft. P: Something loose in cockpit. S: Something tightened in cockpit. P: Dead bugs on windshield. S: Live bugs on back-order. P: Autopilot in altitude-hold mode produces a 200 feet per minute descent. S: Cannot reproduce problem on ground. P: Evidence of leak on right main landing gear. S: Evidence removed.

Qantas Gripe SheetsP: DME volume unbelievably loud. S: DME volume set to more believable level. P: Friction locks cause throttle levers to stick. S: That's what they're there for. P: IFF inoperative. S: IFF always inoperative in OFF mode. P: Suspected crack in windshield. S: Suspect you're right. P: Mouse in cockpit. S: Cat installed.

Qantas Gripe SheetsP: Noise coming from under instrument panel. Sounds like a midget pounding on something with a hammer. S: Took hammer away from midget.

P: Number 3 engine missing. S: Engine found on right wing after brief search. P: Aircraft handles funny. S: Aircraft warned to straighten up, fly right, and be serious. P: Target radar hums. S: Reprogrammed target radar with lyrics.

Wellness Program EvolutionTraditional wellness programsTopic of the month, non targeted, general wellness topics (nutrition, exercise, stress)Disease managementComprehensive campaign on a major health riskWeb basedOn line participation in HRAs, initiatives, coaching

The Hard TruthSuccess is varied and often tied to the efforts of internal champion Challenge is that H&W is ultimately a personal lifestyle choiceCompanies can educate, encourage and even incentivize wellness, however, ultimate decision rests with individual

Human behavior is very hard to changeAND

Factors Affecting Trucker HealthLong workdayssittingWhole Body VibrationStatic PostureBursts of highly physical workPoor dietary choices on the roadSleep issuesDeprivationDisruptionCircadian and biological rhythm interruptionDays, weeks away from homeDecentralized

Most Common H&F Risks for DriversPoor health habitsDriver injuriesDriver fatigueDriver illnessRegular tobacco useOverweight/obese

HypertensionPoor eating habitsLack of physical activityAbuse of Alcoholprescription and non-prescription drugsOTC cold remediesEnergy drinks

ATRI Survey of the Greatest Health Risks Facing DriversManager results: Unhealthy dietObesityStressUncontrolled hypertensionSleep disordersDrug/Alcohol use

Driver results:Sleep disordersDrug/Alcohol useStressObesityUnhealthy dietUncontrolled hypertension

Top H&W Program ActivitiesExercise/physical activity opportunitiesNutrition training/informationWeight management Nicotine prescriptions Tobacco cessation Responsible alcohol use Cardiovascular disease prevention Medication management Disease management for issues such as diabetes and hypertensionFlu shots Fatigue awareness Screening for sleep disordersFocus on ergonomics (cab comfort)

Driver SurveyWhat can be done to get more drivers involved in H&W program?Offering weight room/exercise equipment for driversStart a company sports teamGovernment mandate on H&W program participation

Drivers Components Offered and Utilized the MostEmployee health risk appraisal Nutrition & diet advice/assistance Weight management program Physical fitness programs Blood pressure screening Regular distribution of H&W materials

Safe driving practices and promotion of seat belt use Makes healthy food options available Encourages drivers family members to participate in H&W programs Ensures all vehicles are maintained in ergonomically sound condition

United States Preventive Services Task Force (USPSTF)HypertensionLipid disordersObesityTobacco useBreast, cervical, colorectal cancers

Advisory Council on Immunization Practices (ACIP)Annual Influenza Vaccination for those over 50

National Commission on Preventive PrioritiesRanked preventive care by health impact and cost-effectivenessTobacco use screening and cessation programs 42,000 deaths averted annuallyColorectal screening 14,000 deaths averted annuallyInfluenza vaccination 12,000 deaths averted annually

Washington Workers Behavioral Risk Factor Surveillance System (BRFSS) data76.3% do not eat enough fruits and vegetables61.7% are overweight or obeseSmoking32.4% uninsured14.8% insured3 times as common in homes with annual income< $25,000 than households with incomes >$75,000

ResourcesGuide for Community Preventive Services

Design of an Effective ProgramBusiness Plan (ROI, P/L, PDCA)IntegrationBenefitsCulture

Business PlanHealth Promotion is at the level of Senior Management TeamReports relevant measures regarding the human resourceCosts and cost savings using health metricsBudget to cover all screenings and prevention activitiesIn current corporate environments capital is distributed by demonstrated need and whether the capital distributed was effectively used to help the bottom lineReported in Annual Report to Shareholders

IntegrationNew Employee OrientationBenefits sign upTiered PremiumsNewsletter to FamilyAnnual HRA (mandatory for benefits)Baseline dataBenefit programming (free)derived from HRA Results

BenefitsFree Primary, Secondary and Tertiary Prevention Free screeningsMammographyColonoscopyBPCholesterolFree Tobacco Cessation ProgramsSupport for existing conditions (HBP, diabetes)

Tertiary PreventionEmployees who have developed chronic disease need help in managing their disorderswhy? Decreased disease, death, health care costs, and productivity losses.

BenefitsPercent of employee health insurance costs should be consistent with their participation in the programDiscounts begin with completion of an HRADiscounts increase with participation in relevant programmingFull discount after demonstration of reduced risk (lowered BP, smoking cessation)

Evaluating EffectivenessEmployee behavior is often measured by health risk appraisals that have low participation rates and overrepresentation of health-conscious workers Participants are often compared with nonparticipants, resulting in strong selection bias and overestimation of intervention effect

Workplace evaluation efforts often focus either on inputs such as program delivery that does not capture participation and behavior change disease outcomes, which are slow to change and may be affected by factors outside the intervention.Pitfalls

Evaluating EffectivenessPractitioners working with employers can offer more effective workplace evaluation by: continually tracking intervention delivery and employee participation

measuring relevant behavior change

IncentivesBetter to remove disincentives than install incentivesBarrier-reduction interventions, such as eliminating out-of-pocket costs for tobacco use cessation, should take priority for 2 reasons.they have the broadest reach to workers, dependents, and retirees and can affect all workers, even those who do not participate in interventions financial barriers are most important for low-income workers with limited means

BenefitsWellness Programming should be part of the benefits packageHRA should be a requirement for employees to receive benefitsTobacco/alcohol cessation should be fully fundedScreenings should be fully funded

CultureCulture comes from management walking their talk. Signs dont work, actions do.Celebrating success, learning from failure.If your drivers are your most valuable resource, they need to feel that.

Other areas to addressDepressionMSDsSleep DisordersStress Substance Abuse

How Do I Get Started?Remember H&W program does not need to be all encompassing to begin to address driver health issues Small, incremental steps will make a difference Make sure commitment to improving driver H&W starts at the top and is communicated as such

How Do I Get Started?Analyze health care and w/c claims to identify most prevalent health risks Develop your comprehensive plan with representatives from labor and management and your championScopeMission statement, measureable goals and objectivesMeasurementRealistic budgetCriteria for success (five year plan)

How Do I Get Started?Implement an HRA which will be mandatory if employees are to receive free health benefitsLegal needs to weigh in on HIPAA, and health insurance security.

Starting Small Mail monthly H&W info to drivers homes for driver and family Dedicate section of company newsletter to H&W issues Remember the power of peer pressure and peer influence - drivers provide the best testimonials for one anotherMeet employees where they are.

Stages of ChangePre-contemplation Contemplation Preparation Action Maintenance Termination

It Didnt Work Not convenient/not accessible, particularly for over-the-road drivers Takes too long to see the results set goals too highLack of management support (management not healthy either) No one assigned to manage the wellness program Failure to involve front-line management Championing the program often doesnt start at the top Actions dont support the message (e.g., serving donuts or pizza as a snack or meal during wellness training)

It Didnt Work Champion gets program going and then gets promoted or leaves; no depth in management to carry on Missing a clear statement of philosophy, purpose and goals Ineffective communication Failure to involve employees spouse/family - drivers need support on home front to reinforce the message, change diet, reduce stress, etc. Unrealistic budget Work culture/environment is unsupportive vending machines, smoking areas

It Will Work Do your homework to know what the H&W issues are Set realistic goals and objectives AND performance measures Commitment must be top-down Smart small and dedicate resources (human and financial) to each step Empower drivers to be a part of the process including determination of program components Encourage and foster teamwork among drivers toward common goal

My RecommendationsFind and maintain a championBudget for programs completelyIf you believe in programs, fully fund themEliminate dis-incentivesMeet people where they areStay with itUnderstand that the participation rate will be low for some timeIntegrate wellness and safety and health, they belong together anyway (Health and Productivity).Wellness is a performance measure.

Thanks for being here!Any Questions?thank you for listeningDo you have questions?

After every flight, pilots fill out a form called a gripe sheet, which conveys to the mechanics problems encountered with the aircraft during the flight that need repair or correction. The mechanics read and correct the problem, and then respond in writing on the lower half of the form what remedial action was taken, and the pilot reviews the gripe sheets before the next flight. Never let it be said that ground crews and engineers lack a sense of humor. Here are some actual logged maintenance complaints and problems as submitted by Qantas pilots and the solution recorded by maintenance engineers. By the way, Qantas is the only major airline that has never had an accident. (P = The problem logged by the pilot.) (S = The solution and action taken by the engineers.) P: Left inside main tire almost needs replacement. S: Almost replaced left inside main tire. P: Test flight OK, except auto-land very rough. S: Auto-land not installed on this aircraft. P: Something loose in cockpit. S: Something tightened in cockpit. P: Dead bugs on windshield. S: Live bugs on back-order. P: Autopilot in altitude-hold mode produces a 200 feet per minute descent. S: Cannot reproduce problem on ground. P: Evidence of leak on right main landing gear. S: Evidence removed. P: DME volume unbelievably loud. S: DME volume set to more believable level. P: Friction locks cause throttle levers to stick. S: That's what they're there for. P: IFF inoperative. S: IFF always inoperative in OFF mode. P: Suspected crack in windshield. S: Suspect you're right. P: Number 3 engine missing. S: Engine found on right wing after brief search. P: Aircraft handles funny. S: Aircraft warned to straighten up, fly right, and be serious. P: Target radar hums. S: Reprogrammed target radar with lyrics. P: Mouse in cockpit. S: Cat installed. P: Noise coming from under instrument panel. Sounds like a midget pounding on something with a hammer. S: Took hammer away from midget.

*Employers also will be more motivated to support effective interventions if they can see that the resources going to these interventions result in program participation and behavior change.*Precontemplation not interested in making changesContemplation - "people are intending to change in the next 6 months" Preparation - "people are intending to take action in the immediate future, usually measured as the next month Action - "people have made specific overt modifications in their life styles within the past 6 months Maintenance - "people are working to prevent relapse," a stage which is estimated to last "from 6 months to about 5 years" Termination - "individuals have zero temptation and 100% self-efficacy... they are sure they will not return to their old unhealthy habit as a way of coping"

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