generating & measuring healthy workplace outcomes health work & wellness conference...

Generating & Measuring Healthy Workplace Outcomes

Health Work & Wellness ConferenceSeptember 30, 2010

Peter Melnyk PhD & Allan Smofsky

Agenda

- Literature review: WHP in Canadian worksites

- Components of Canadian WHP strategies

- WHP program evaluation

- Literature review: WHP in Canadian worksites

- Components of Canadian WHP strategies

- WHP program evaluation

- Emerging definition of healthy workplace: what it means to different stakeholders

- Measuring healthy workplace outcomes

- Generating healthy workplace outcomes: some emerging opportunities

- Emerging definition of healthy workplace: what it means to different stakeholders

- Measuring healthy workplace outcomes

- Generating healthy workplace outcomes: some emerging opportunities

Employer survey:

- Focus on Canadian employers

- New/emerging strategies

Employer survey:

- Focus on Canadian employers

- New/emerging strategies

where are we now? where are we going?

Background evolution of WHP understanding:

“a marketing process which produces widespread and

sustained employee participation in

healthful activities”1

employee health is a combination of

personal and worksite inputs

more comprehensive WHP initiatives need a more scientific approach: clear objectives and well defined endpoints/outcomes robust evaluation of program outcomes clear positioning/integration of WHP within the corporate culture

1. Wilbur CS Prev Med 1983;12(5):672-81

Initial Objectives

Review the biomedical literature and other publicly available sources of information on the topics of:

workplace health promotion (WHP) and disease management in Canada

to identify:

best practices key clinical humanistic and economic outcomes measured in WHP evaluation

most articles were retrieved from a structured PubMed search of peer-reviewed literature:

approximately 35 studies meeting the search criteria were published and indexed by PubMed over the last 5 years

other sources investigated: Canadian Association for Population Therapeutics (CAPT) meeting abstracts, Public Health Agency of Canada, Canadian Healthy Workplace Council

Methods

screening abstracts

full text screening

data extractionPubMed

key search terms

General Results I

the Canadian WHP programs identified primarily targeted:

cardiovascular health, general health, musculoskeletal disorders

disease management – absent from the peer reviewed literature..

1. Public Health Agency of Canada. Active living at work - Trends & impact: the basis for investment decisions. 2007. http://www.phac-aspc.gc.ca/alw-vat/trends-tendances/index-eng.php

cardiovascular, musculoskeletal,

respiratory,digestive, cancer, stress.

70%

benefit costs1

otherdisease categoriesthese

conditions are preventable or modifiable

through behavioural

changes

Key factors that contribute to successful WHP initiatives are:

General Results II

Successful WH

Strategy

Targeting several health issues

Attaining high participation

Integrating WHP into the organization’s culture and

operations

• Integration of occupational health and safety with workplace wellness:

• enhanced effectiveness

• employee receptivity

• time & access .on-site services

• incentives

``

Increasing focus among employers on employee health and well-being much of the focus has been on education to modify personal health practices studies report that—to be truly effective—a workplace wellness program must consider

appropriate organizational and policy changes

2009 Buffet and Company2 survey (N=634): many initiatives not designed to

generate outcomes (e.g. flu shots)

Workplace Wellness Programs in Canada

2. Buffet and Company. 2009 Wellness Survey.,3. Stewart N. The Conference Board of Canada, 2010

0

10

20

30

40

50

60

70

80

90

100 91%

44% offer some type of wellness initiative

1997 2009

2010 Conference Board of Canada Survey (N=255):3

Workplace Wellness Programs in Canada

3. Stewart N. The Conference Board of Canada, 2010

0

10

20

30

40

50

60

70

only 26% of respondents reported that their organization has fully developed a comprehensive wellness strategy

64% of survey respondents agreed that their benefit programs focused on health promotion and disease management, but…

The most commonly offered elements of WHP initiatives among Canadian employers include: employee assistance programs: 94-97% CPR/first aid training: 84% flu shots/immunizations: 78-83%

The least commonly offered components: on-site medical care: 19-21% 24 hour nurse line: 22% fitness counselling: 17-22%

There is variability in the types of components offered in different regions of Canada

Components of WHP programs offered in Canada

• often offered as stand alone measures not strategically

incorporated as part of a comprehensive WHP approach

• conclusive evidence on the impact of EAP on performance is needed

Data on employee health/well-being is typically gathered using a macro perspective which is difficult to reconcile with the more granular employee

engagement/productivity data

Lack of robust data collection in the area of employee health: The literature describes a number of reasons for this

many managers simply accept that healthier employees are more productiveemployee health not consistently managed or monitored by health professionalshuman resources professionals may not receive training necessary to interpret

and manage employee health and wellness resources/tools available

Program evaluation I

Program evaluation is a key component of long-term success; however detailed measures of WHP program impact on health risks, employee productivity and costs are often not collected

Tune Up Your Heart1 – designed with a focus on measurement and evaluation of health outcomes

risk assessment; tailor intervention to risk strata measurements of systolic and diastolic blood pressure, lipid levels & BMI smoking and diabetes status were determined pre/post analysis of statistically significant changes in components of risk historical data: annual per capita costs for life insurance, absenteeism, STD, LTD and prescription drugs

Outcomes: components of risk risk status economic outcomes

Program evaluation II

1. Chung M, et al. Worksite health promotion: the value of the Tune Up Your Heart program. Popul Health Manag. 2009 Dec;12(6):297-304.

Health & Well-being Primary health and well-being outcome measures

used in studies identified in the literature search:

body mass index short term disability

blood pressure cholesterol and triglyceride levels self-reported stress level smoking cessation rate

Other metrics?

Evaluation metrics

Economic Primary economic/productivity outcome measures used in identified studies:

absenteeism WCB costs short-term disability claims annual grievances

Evaluation of WHP success or failure not based on any single metric

Evaluation metrics

Defining a Healthy Workplace – current (Canada)

Safe & Healthy Work Environment

Supportive

Organizational / Work

CulturePersonal H

ealth/

Lifestyle Practic

es

Healthy, Productive, Successful Workplaces

WHO Definition of Health

Health: A state of complete physical, mental and social well-being, and not merely the absence of disease

Workplace Health (new): A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace by considering the following, based on identified needs:

health and safety concerns in the physical work environment health, safety and well-being concerns in the psychosocial work environment, including

organization of work and workplace culture personal health resources in the workplace; and ways of participating in the community to improve the health of workers, their families and

other members of the community.

Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010

Safe & Healthy Work Environment

Personal Health / Lifestyle

Resources

Corporate Social Responsibility

Supportive Psychosoc

ial Work

Environment

Mobilize

Assemble

Assess

Prioritize

Plan

Do

Evaluate

Improve

LeadershipEngagement

Employee Involvement

LeadershipEngagement

Employee Involvement



Defining a Healthy Workplace- new

Adapted from World Health

Organization, 2010

Safe & healthy work environment includes: Physical work environment: structure, air, machinery, furniture, products, chemicals,

materials and production processes in the workplace¹ Process Elements

Ergonomics Emergency response Injury prevention Disability case management Environmental practices

Culture Elements Assessing impact of work culture on health & safety performance Supervision Empowerment Teamwork Workload Harassment/bullying prevention & management

¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010 http://www.who.int/occupational_health/publications/healthy_workplaces_model.pdf

Defining a Healthy Workplace

http://www.who.int/occupational_health/publications/healthy_workplaces_model.pdf

Personal Health / Lifestyle Resources include: The health services, information, resources, opportunities, flexibility and otherwise

supportive environment an enterprise provides to workers to support or motivate their efforts to improve or maintain healthy personal lifestyles, as well as to monitor and support their physical and mental health¹

Awareness / prevention, risk identification / prioritization, and targeted support

Disease management




Supportive psychosocial work environment includes: Organizational culture as well as attitudes, values, beliefs and daily practices in

the enterprise that affect the mental and physical well-being of employees¹

Enshrining importance of employees in org. mission/vision/strategy Effectively communicating this both internally & externally Developing policies that reflect this

Management practices; walking the talk! – making people policies “real”

Understanding employee drivers, attitudes and perceptions

Work flexibility; work-life balance

“Fair work conditions" : Work demands are reasonable Input/decision making is maximized Feedback & recognition are adequate



Job Satisfaction > Job Stress



Corporate Social Responsibility (CSR) includes: The activities in which an enterprise might engage, or expertise and resources it

might provide, to support the social and physical wellbeing of a community in which it operates. This particularly includes factors affecting the physical and mental health, safety and well-being of workers and their families¹

Examples Supporting community health awareness/prevention campaigns/initiatives Environmental awareness/practices Providing leadership, expertise and support related to comprehensive workplace health to

other businesses


¹¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010

Implications for organizations: providing opportunities for employees to participate in CSR activities (e.g. Habitat for Humanity) can enhance employee engagement in addition to supporting the organization’s CSR strategy and benefitting the community


Primary Drivers of Comprehensive Workplace Health

2 key elements essential to successfully implementing and sustaining actions that support all 4 elements of comprehensive workplace health

1. Leadership Creating and facilitating an environment in which all employees can work together towards

optimal employee health and organizational performance Should occur at all levels

2. Employee Engagement Satisfaction: The level of contentment or passion a person associates with his or her

job/position and the organization Commitment: Inspiration to do one’s best work; to perform at levels beyond what is

expected, while making a meaningful commitment to improving one’s personal health and enhancing organizational performance

Adapted from Ontario Healthy Workplace Coalition Healthy Workplace Model ,2010

The Stakeholder Outcomes They Care About

HR Engagement, Health costs

Finance Positive ROI, Profitability

Occupational Health Employee health, Absenteeism

Operations Productivity & Performance

Sales/Marketing/Customer Service Sales, Customer satisfaction / loyalty

Executive Profitability, Attraction/retention, CSR

(enhanced reputation)

Labour Member satisfaction, health & well-being

Each employee Health/well-being, Stress

Government Population health, Labour productivity

healthcare cost trend

Community Contribution to community benefit;

improved community well-being

Healthy Workplace – Who Cares?

MEASURING OUTCOMES

Healthy Workplace Outcomes Measurement- Guiding Principles

1. Understand your organization’s key issues & cost drivers that impact employee health/well-being Determine key benchmark measures & establish baseline

2. Include qualitative measures (e.g. how employees say they manage their health) as well as quantitative

3. Consider both lagging and leading indicators

4. Determine desired objectives/outcomes; establish linkages between outcomes where possible at outset & factor into evaluation methodology

5. Evaluate at identified milestones on an ongoing basis

6. Standardize and align data requirements across all relevant vendors where possible

7. Compare where possible to relevant norms – Canadian, industry specific, etc.

8. Link to external best practice standards such as BNQ¹/GP2S, NQI, etc.

BNQ¹: Bureau de Normalisation du Québec: BNQ 9700-800 norm: "Healthy Enterprise" Prevention, Promotion and Organizational Practices Contributing to Health in the Workplace

Healthy Workplace Outcomes Measurement - Lagging Indicators of Health

The “economic burden” of illness and injury –defined costs spent on events that have already occurred

Health & drug claims Absenteeism Short/Long Term Disability EAP utilization Accidents Turnover Productivity Profitability

Outcomes Measurement – Leading Indicators of Health (Measuring Risk)

Leading indicators of health are predictive of health issues and therefore predictive of health claims and other issues to come

Physical Activity Obesity Tobacco Use Substance Abuse Stress / Resilience Environmental Quality Access to Health Care Engagement Health management attitudes / habits Presenteeism Customer satisfaction/loyalty

Population Health Trends

Diabetes: Economic burden of Diabetes is currently $12.2bln (2X 2000 level) – projected to rise to $17bln by 2020 – Canadian Diabetes Association 2010

Cancer: Costs are doubling every 2-3 years. The model of cancer care is that of adding-on to existing treatments. Rarely does a new therapy substitute of an older one. In ON, cancer drugs cost $22.9mln; $79.1mln in 2006 – Report Card on Cancer, 2007

Obesity: Employees with BMI>40 vs. recommended weight: Lost workdays per 100 FTE’s - 183 vs. 14 Medical claims costs per 100 FTE’s - $51,091 vs. $7503

- Obesity and Workers Compensation; Arch Intern Med; Apr. 2007

Implications for organizations: How many of you measure the direct impact of diabetes, cancer and obesity on your organization? Do you consider the indirect impact on overall taxes of those costs which are

covered by the public health system? Do you assess cost competitiveness versus other countries where a greater proportion of these costs are borne

by the private sector?

Why Link Workplace Outcomes?

Well-being-Absenteeism link: Actual work time lost for personal reasons increased from 7.4 days per worker in 1997 to 9.7 days in 2006 – Statistics Canada 2007

Engagement-Absenteeism link (1): For every 100 workers, 47 disability days reported for “Very satisfied” workers vs. 129 disability days for “Not at all satisfied” workers – Unhappy on the Job, Health Reports 2006

Engagement-Absenteeism link (2): High-engagement organizations: 6.38 absenteeism days/year per employee; lower engagement organizations: 12.89 days - Best Employers in Canada, Hewitt 2009

Wellness-Sick days link: Dow Chemical - Of those who participated in moderate or intense weight management intervention, the average number of lost work days due to illness decreased from 3.9 days in 2006 to 3.4 days in 2007 - Emory University Rollins School of Public Health, 2009

(More) Why Link Workplace Outcomes?

Engagement - Well-being link: Sr. mgmt. interest in employee well-being is a key driver of engagement; however, less than 10% of employees agree that senior leaders treat employees as vital corporate assets – Global Workforce Study, Towers Watson, 2008

Engagement - CSR link: 53% of employees would take a pay cut to work for an employer with a reputation for caring about employees and the community – Kelly Services survey (7,000 employees), 2009

Wellness-Engagement link: 45% of Americans in small-medium sized companies would stay at their jobs longer because of employer wellness programs; 40% were encouraged to work harder and perform better; 26% missed fewer days of work by participating in wellness - The Principal Financial Group , Well-Being Index, 2009

Health & Safety Culture

Safe & Healthy Work

Environment

Working Relationships

Personal Growth & Aspiration

Workplace Health & Well-Being – an Outcomes Framework

Physical Health• Musculoskeletal

• Energy• Safety performance

Social Health• Trust

• Fairness• Connectedness

Psychological Health

• Stress• Overall health

• Control

Leadership/Manager

Effectiveness

Employee health/

well-being

“Health” Metrics- Absenteeism /

Presenteeism- Attraction /

Retention- Health benefits

cost

Business Metrics- Productivity- Customer

satisfaction / loyalty- Financial

performance

Corporate Social Responsibility

Personal Health/Lifestyle

Resources

Supportive Psychosocial

Work Environment

Health & Safety Process

Physical Work Environment

Employee involvement in

CSR

Awareness/ prevention

Risk identification tools/ targeted

support

Linking drug and disability data -an example of a broader outcomes approach

In a 3-year study of employees with rheumatoid arthritis*, the researchers found that: Higher employee out-of-pocket payments may lead to lower medication

adherence As members’ out-of-pocket costs increased by $20 above the baseline, there was a

35% decrease in the percent of the population filling at least one prescription People who adhered to their medication had fewer incidences and shorter

durations of short-term disability claims For members who did not fill a prescription, STD incidence rate was 36%, compared to

23% for members who filled at least one prescription Members who did not fill a prescription averaged 5 days longer STD duration than

members who did fill a prescription

* Integrated Benefit Institute, Research Insights- “The Blind Man and the Elephant” , 2007

Implications for organizations: plan design and pricing decisions must consider the impact on the full spectrum of programs, taking into account integrated data and metrics; in the above example, the benefits strategy

would logically include promoting medication adherence

GENERATING OUTCOMES

34

Workplace Health & Well-being – A Continuum & Planning Framework

Health PromotionHealth Risk

ManagementSelf/Professional

CareCase Management

Opportunities for Integrated Prevention/Care Management Interventions

WellE.g., low risk, good nutrition,

active lifestyle

At Risk E.g., inactivity, high stress,

overweight, high blood pressure, smoker

Catastrophic Conditions

E.g., severe burns, premature infant, head injury

Community-based programs (awareness/prevention)

Targeted health risk assessment Self-care triage tool Utilization management

Immunizations Targeted behavior modification (e.g. health coaching)

Telephonic//E-consults/Clinician visit

Disease-specific Case management

Health Screening-HRA & biometrics

Stress/mental health management Post- decision support Care coordination

Health information resources Community-based programs (risk-specific) Social supportOccupational health and

safety

Acute ConditionsE.g., respiratory, strain and

sprains, lacerations

Behavioral and clinical support

Disease Management

Patient identification and enrollment

Care coordination

Address co-morbid conditions

Chronic ConditionsE.g., prevalent diseases and

chronic conditions

“Preventable illness makes up approximately 70% of the burden of illness and its associated costs. Well executed health promotion programs can show savings of up to 20% in the first year.” - Dr. James Fries, Beyond Health Promotion: Reducing the Need and Demand for Medical Care, 1998

A Word About Chronic Disease

When employees suffer from chronic diseases, organizations can experience lost productivity and lost opportunities, e.g.:

increased employee absenteeism; increased disability; increased accidents; reduced workplace effectiveness; and negative impacts on work quality or customer service¹

Globally, mortality from chronic disease is about 56 percent of all deaths among the working-age population and is the main factor behind lost work time in this group²

Businesses have a vital role in the prevention and management of chronic diseases, and also in helping their employees—who live with chronic conditions—to enjoy a high quality of life, and work productively. This role is critical to individual health and well-being, firm-level success, sector performance and, ultimately, the overall prosperity of Canada³

¹World Economic Forum, Working Towards Wellness: The Business Rationale, (Geneva: World Economic Forum, 2008

² World Economic Forum, Working Towards Wellness: The Business Rationale (Geneva: World Economic Forum, 2008

³ Addressing Chronic Diseases-What’s Business Got to Do With It?, The Conference Board of Canada, Sept. 2010

CWH Implementation Process

Take Stock Take Action Evaluate

1. Take Stock: Monitor, measure, and report data that reflects workplace health and organizational performance

Monitor: Identify & assess key workplace health issues Measure: Gather available data or measure using relevant tool Report: Identify gaps and review results with relevant stakeholders

2. Take Action: Develop a healthy workplace strategy and implement a plan to best address the needs and gaps identified in taking stock phase

Plan: Set goal and identify programs, processes or policies needed; develop action plan Act: Implement action plan

3. Evaluate: Evaluate outcomes and report on effectiveness and impact of the plan Evaluate: Use tools to evaluate process, determine if plan has been fully implemented, and

if goals have been met Revise: Identify what should be continued, stopped, or revised. Start CWH implementation

process over as necessary.

Adapted from ON Healthy Workplace Coalition Healthy Workplace Model 2010 ADD LINK

Generating Outcomes – Emerging Opportunities

Emergence of effective tools to measure costs & identify outcomes opportunities More wellness offerings by mainstream workplace health service providers - but

often not seamlessly linked to core offering (e.g. Life/health carriers – wellness/prevention)

Need greater integration of traditional services (e.g. proactive referral of STD/LTD claimants to EAP)

Need greater integration of new/emerging workplace health/wellness services with each other AND with existing services (e.g. synch HRA and biometric screening initiatives and link results with flex benefits enrollment process)

More emphasis on disease management – new entrants to workplace health market

Employer coalitions

Generating Outcomes – (More) Emerging Opportunities

Employee health/well-being as part of Corp. Social Responsibility (CSR) strategy Workplace health common standards & model

e.g. ON Healthy Workplace Coalition Certification – GP2S, NQI, etc. Multi-stakeholder collaboration – all workplace health stakeholders Measure societal impact of workplace health initiatives (e.g. utilization of public health

resources) Can help to provide the business case for government to consider incentives for workplace

health improvement

Conclusion

The good news: Considerably greater business emphasis on the importance of employee health and well-being

The challenge/opportunity:: Health/well-being to become “way of doing business”; heightened emphasis on evaluation and generating outcomes; health indicators will increasingly be linked to key organizational drivers

Caution: Health/well-being resources, programs & initiatives that do not demonstrably enhance key organizational drivers will become superfluous

Several reports have been published with respect to WHP programs amongst Canadian employers

Initial phase - reviewed existing WHP literature Next – Employer survey to better understand information on WHP initiatives

that are emerging or otherwise not found in literature review This survey and case studies will add to the current body of knowledge by

assessing: What health and wellness metrics are used in program evaluation? How are health metrics related to specific employee productivity metrics? Are WHP programs being developed/modified in response to specific issues

identified through a process to assess employee health issues/needs? What is the ROI of given WHP programs? Do incentives play an important role in employee participation? Are incentives

evolving beyond awareness towards “taking action”

Next Steps- Employer Survey

Survey – a call to action

Selected Canadian employers were initially asked to participate in the survey in Summer 2010

Survey now ready for broader distribution Learning opportunity:

subset aggregate report for HW&W Conference attendees participants will have access to survey results to help inform dialogue on WHP going forward

The survey as well as background and contact information is available at:http://www.biomedcom.org/en/whpstudy/

http://www.biomedcom.org/en/whpstudy/

• you can take more than one session to complete the survey; remember to Save before Logging Out • when you have completed the survey, check Survey Completed, click Save, and then Logout

Program Evaluation: Nearly ¾ of responding employers formally evaluate their programs

health metrics, outcomes – yes ROI – not measured

Incentives: Nearly all employers surveyed provide incentives for participation… …more than ½ provided incentives for TAKING ACTION

Survey – early returns

While at HW&W please visit the Internet Café and complete your survey on the spot!

If you have any questions concerning the WH survey or any aspect of this presentation, please contact Peter or Allan at:

[email protected]@cogeco.ca

mailto:[email protected]

mailto:[email protected]

generating & measuring healthy workplace outcomes health work & wellness conference...

Documents

workplace health promotion

whp evaluation slide

canadian whp programs

successful whp initiatives

workplace wellness

general health

employee health

comprehensive whp initiatives