Posts from — December 2008

As they say: “timing is everything.” Use the guidelines below to guide the timing of Company Health and  Wellness Program activities and data collection.

Timing: Company Health and Wellness Program Start-up
• Look at the optimal time to start a new Employee Wellness Program. Take into account preferences of  the target population and other factors that could affect enrollment and participation.
• For example, coordinating the start of an adult weight management initiative with the start of school  in August or September may be a good tie-in with a “fresh start.”
• On the other hand, starting an adult weight management initiative In January may not be a great idea  because of the constraints that weather may put on exercising outdoors.
• Make use of other timing cycles at your company. Planning a marketing blitz just after the PCS  turnover has been completed is a good way to let new personnel know what Company Health and Wellness  Program options are available.

Timing: Company Health and Wellness Program Participant Support
• Look at how frequently Company Health and Wellness Program sessions should be offered to provide the  best support and education for participants and the best opportunity for success.
• Get feedback from participants regarding what session frequencies work best for them.
• Look at the timing for other support mechanisms like email encouragement. What timing of those  messages will benefit participants most: Weekly? Bi-monthly? Monthly?

Timing: Company Health and Wellness Program Data Collection
• Collecting data is an excellent way to track member progress and also to identify potential problems  within a Employee Wellness Program. So, give some thought to the frequency and timing of data  collection.
• Select metrics that can realistically change during the Company Health and Wellness Program  implementation time period. For example, BMI and weight may not change very much during a 10-week  Employee Wellness Program; however, step counts are more likely to noticeably change.
• Some data, such as member responsiveness to out-of-class assignments (like food journals) and other  interim data (like step counts) will provide important information needed to “adjust fire” as needed  and make Company Health and Wellness Program changes if something is not working.
• Be flexible regarding data collection frequency. Instead of requiring that participants complete an  physical fitness log every day, for example, consider asking for a “snapshot” summary from two or three  days during the week. You will still get information to review, but participants will have an easier  time complying with the assignment.

Timing: Company Health and Wellness Program Follow-up
• Because the we are such a mobile population, it’s best to plan some sort of post-Employee Health and  Wellness Program follow-up data collection within two to four months after the Company Health and  Wellness Program ends.
• You can always try to collect additional follow-up data at 6 or 12 months after Company Health and  Wellness Program completion. However, if you collect the data sooner, you’ll at least have collected  some short term Company Health and Wellness Program impact information before participants are lost to  follow-up.

Company Health and Wellness Program communication is important to all aspects of Wellness and  preventive medicine and is relevant to:
• Healthcare provider-patient relationships
• An individual’s exposure to, search for, and use of Company Health and Wellness Program information
• Effective counseling and patient education for behavior change
• Content of public health messages and community campaigns

Effective health communication should have these attributes:
• Accuracy: content is valid and error-free
• Availability: delivered or placed where the intended audience can access the information
• Balance: content presents benefits and risks of potential actions
• Consistency: content is locally consistent over time and is also consistent with information from  other reliable sources
• Evidence-based: content and methods of delivery are based on relevant scientific proof
• Reach: content gets to or is available to as many staff members as possible in the target population
• Reliability: content source is credible; content is kept up-to-date
• Repetition: delivery of/access to the content is continued over time, to reinforce the impact with  the audience and to reach new members of the target population
• Timeliness: content is provided when the audience is most receptive to, or in need of, the specific  information
• Understandability: reading, language levels, and format are appropriate for the specific audience  (i.e., Employees, Family Members, Garrison leadership, etc.)

What the research says about health communication
• Health communication best supports Wellness when multiple communication methods are used to reach  specific audiences.
• Effective Wellness and communication initiatives should reflect an audiencecentered perspective, and  reflect the preferred formats, contexts, and way of communication for the intended audience.

Material adapted from: United States Department of Health and Human Services. Healthy People 2010. 2nd  ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington,  DC: United States Government Printing Office, November 2000.
http://www.healthypeople.gov/document/HTML/Volume1/11HealthCom.htm

Evaluation of successful Employee Wellness Programs has revealed several key Company Health and  Wellness Program strategies to increase Company Health and Wellness Program effectiveness and impact  overall Soldier health.

Strategy #5: Using a small number of targeted priorities maintains Company Health and Wellness Program  focus.
• Needs assessment data can be used to identify leading health and wellness needs and also high risk  populations.
• Choosing a handful of specific health and wellness needs on which to focus will maximize efficient  use of resources.
• Keeping the Company Health and Wellness Program focus small will avoid duplication of other ongoing  company Employee Wellness Programs.

Strategy #6: Use standardized processes whenever possible.

Reduce the amount of variation within your Employee Wellness Programs by standardizing all the  processes needed for Company Health and Wellness Program planning and begination. For example:
• Use the same spreadsheet format for data collection so that the columns are in the same order. This  way you can compare data more easily.
• Reuse the same forms for enrollment and attendance. Change the heading as needed.
• Look at other Company Health and Wellness Program processes (like registration, evaluation,  marketing, etc.). What parts of those processes can be standardized?
• The Wellness and Prevention Initiatives website (http://chppmwww.  apgea.army.mil/dhpw/Population/HPPiFunction.aspx) has many standardized Company Health and Wellness  Program resources in a variety of topic areas.

Strategy #7: Company Health and Wellness Program delivery methods should be flexible and adapted to  population needs.
• Delivery of products and services may depend on: company needs, training requirements, other  scheduling considerations (such as work/duty schedules, school scheduling, etc.), member preference,  and/or availability of staff or space.
• Be flexible: the same produce/service delivery methods may not work for every population.
• Some company’s may want services provided to them as close as possible to the company location; other  companies may prefer as many services as possible bundled together at once (regardless of location).
• Take wellness and preventive medicine beyond the walls of the employer in order to meet leadership  and worker needs. Answer the question: “How can we best help leadership and Employees to fulfill their  mission?”

Evaluation of successful Employee Wellness Programs has revealed several key Company Health and  Wellness Program strategies to increase Company Health and Wellness Program effectiveness and impact  overall Soldier health.

Strategy #1: Communication with leadership is essential
• Assess leadership priorities.
• Report Company Health and Wellness Program outcomes back to leadership in a timely manner.

Strategy #2: Company Health and Wellness Program planning must be driven by data.
• Determine specific needs of the target population.
• Focus on the health status of the population as a whole to identify the top health concerns.
• Information should drive decisions regarding which health and wellness needs should be addressed  first.

Strategy #3: Use electronic data collection and reporting as often as possible.
• Centrally collected data in an electronic format is fundamental for determining population health and  wellness needs.
• Electronic reporting is also very valuable when communicating Company Health and Wellness Program  outcomes to leadership and other stakeholders.
• Flexible reporting capabilities allow data to be presented as information that can support  decision-making, in formats that decision-makers prefer.

Strategy #4: Multidisciplinary collaboration enhances worker health and maximizes available resources.
• Collaboration between health disciplines increases effectiveness of Wellness and preventive medicine  initiatives.
• Don’t forget to look outside the employer for collaboration partners.
• Optimized Company Health and Wellness Program outcomes can be achieved by coordinating the activities  of medical professionals, cadre, community agents, and funding sources.
• Bundling services together also provides the additional benefit to units by conserving training and  mission time.
Implementing these strategies can improve Company Health and Wellness Program effectiveness and  optimize available resources.

Changing health-related behaviors is a difficult challenge. Incorporate the tools below into your  Wellness initiatives to assist participants in successfully changing health behaviors.

Tool #1: Establish effective goals
• Focus on areas that can impact the overall goal.
• For example, if the overall goal is to lose weight, the most productive areas to  focus on are the dietary and activity changes that will lead to long-term weight loss.
• For example, stress management and improving self-esteem may also impact weight loss;  however, improving relationships, while a worthwhile topic, will not necessarily impact weight loss.
• Make the goals specific, attainable, and forgiving. For example:
• “Exercise more” is too general.
• “Walk five miles everyday” is specific, but may not be attainable.
• “Walk 30 minutes everyday” is specific and more attainable, but is not very flexible.
• “Walk 30 minutes, five days a week” is specific, attainable, and forgiving.
• Use a series of short-term goals to achieve the ultimate goal.
• Short-term goals break big challenges into more easily attained pieces.
• Smaller steps also provide Company Health and Wellness Program participants with  encouragement and success. These small successes are essential for maintaining motivation towards a  long-term goal.

Tool #2: Increase self-awareness
• Self-monitoring is useful for tracking behavioral and environmental cues that trigger a  particular behavior.
• Keeping track of behavior status is also useful for times when progress towards a goal is  difficult to measure, or when an individual is in a maintenance stage.

Tool #3: Provide rewards and motivation
• Encourage participants to reward themselves for achieving small successes on the way to their  ultimate goal.
• Remember that rewards don’t always have to be “things.” Words of encouragement and praise can  provide powerful motivation when spoken by a teacher, instructor, parent, friend, etc.

Tool #4: Respond effectively to set-backs
• behavior change is conceptually a continuum. However, movement along that continuum is not  just in one direction. Workers can move backwards or forwards or sometimes just stay put. Communicate  to participants that set-backs, lapses and even staying the same (i.e., maintenance) are common for  individuals trying to change behavior.
• Stress is often a factor in lapses and relapses. Provide a variety of stress management  resources to help participants better handle the stress which could trigger a set-back.
• Brain storm to create a list of potential (and probable) obstacles to member behavior change.  Then formulate strategies to meet each of those challenges.
• Enhanced time management and decision-making skills can be effective ways to overcome  behavior change relapses.
• Provide participants with information regarding the behavior change process so that they will  be better prepared for the challenges they will face. A brief overview of the Stages of Change may be  helpful.

The majority of corporations do not have the Company Health and Wellness Program resources to address  all of their health and wellness needs at once. Priorities must be set to determine the most pressing  health and wellness needs. Use the steps below to prioritize company Wellness needs.

Assess the health and wellness needs of the population.

Collect data about the health and wellness needs in the community. How?

• Community- or target group-specific surveys

Establish health and wellness needs and at-risk populations.

Use the data to identify leading health and wellness needs and also high risk populations. For example:
• Obesity and overweight
• Injury prevention
• Self care

Reduce the list.

Not every health need can (or should) be addressed. Use the following questions to determine which  health and wellness needs should be addressed first.
• How does the health need impact operational readiness? How big is the impact?
• What are the Senior Management priorities? How does the health need fit into those priorities?
• What are the behavioral factors affecting the health need? What is the proof that a behavior change  will make a difference? Has the behavior been successfully changed by other Employee Wellness Programs?
• What other physical, social, or environmental factors influence the health need or the target  population?
• Is the health need a greater problem at the local level than in the United States population as a  whole?
• Does the employer have the subject matter expertise and resources to address the health need?

Develop Company Health and Wellness Program recommendations.

Only a handful of specific health and wellness needs should be focused on in a given year. Keep the  following in mind as recommendations are developed as to which specific health and wellness needs will  be addressed:
• Avoid duplication of other ongoing Employee Wellness Programs whenever possible. Establish Employee  Wellness Programs already addressing the health need and/or the target population.
• Establish and assess available resources. Build on existing services whenever possible.

Use the recommendations to offer tailored, targeted, integrated initiatives to address the prioritized  list of health and wellness needs. Prioritizing health and wellness needs will keep Employee Wellness  Programs focused, maximize efficient use of resources, and align Wellness efforts with Senior  Management goals and priorities.

Keeping the bottom line up front Bottom Line Up Front in Company Health and Wellness Program will help  you get and sustain Senior Management support. A Bottom Line Up Front approach will also help you more  realistically measure the impact of your Employee Wellness Program.

The bottom line in Employee Wellness Programs answer two key questions:
• How will member health be improved?
• What’s in it for Senior Management?

The ultimate bottom line: all roads should lead to readiness.
• Always be ready to communicate to leadership the ways that your Company Health and Wellness  Program impacts readiness.
• Think like Senior Management: what Company Health and Wellness Program outcomes will be  important from a Senior Management point of view?
• Develop line-centered language that communicates those outcomes.
• Ask participants how they think a particular Company Health and Wellness Program enhances  force readiness. This input is a valuable source of information.

Use the following steps as a Bottom Line Up Front approach to Employee Wellness Programs.

Step 1: Think about the end of the Company Health and Wellness Program first and plan backwards.
• It has been said, “If you don’t know where you’re going, any road will get you there.”
• Before planning or implementing any part of the Employee Wellness Program, be able to answer  the questions: how will member health be improved? What’s in it for Senior Management?

Step 2: Establish concrete Company Health and Wellness Program outcomes.
• Establish up front what the Company Health and Wellness Program is working towards.
o For example: will participants lose weight? Walk more steps? Decrease injuries? Move  to another stage of change?
• Establish any processes or procedures that will be improved.
o For example: which pharmacy operations will become more efficient? How will  record-keeping be streamlined?

Step 3: Determine what will be measured to show that Company Health and Wellness Program goals were  achieved.
• Look at what data is really needed to show Company Health and Wellness Program effectiveness.  Avoid the temptation to collect every possible piece of data. Choose a handful of important data points  and stick to those.
• Think backwards when deciding what data to collect – consider how easily follow-up data can  be collected when a Company Health and Wellness Program ends. Getting follow-up data is often a  challenge.
• Only collect data for health behaviors or indicators that the Company Health and Wellness  Program actually affected.
o For example: if the main Company Health and Wellness Program goal is that  participants will walk more steps, then it may be better NOT to choose changes in cholesterol level as  a Company Health and Wellness Program outcome (unless the Company Health and Wellness Program  specifically addresses cholesterol).
• Avoid measuring outcomes that the Company Health and Wellness Program cannot (or did not)  affect.

Step 4: Determine what Company Health and Wellness Program elements must be included to move  participants towards the Company Health and Wellness Program goals.
• The concrete Company Health and Wellness Program outcomes identified in Step 2 are the  compass for keeping the Company Health and Wellness Program on track. All Company Health and Wellness  Program elements should lead towards that ultimate goal.

Working backwards when planning and implementing Employee Wellness Programs is really forward thinking.  Keeping the bottom line up front is a smart approach to Employee Wellness Programs.

Health Information Technology can make the entire health care system more effective and efficient by  enhancing:
• Documentation (lab and test results, clinic notes, consult recommendations)
• Communication (provider to patient, provider to provider)
• Information input (templates to facilitate data entry)
• Delivery of care (documenting all patient-provider interactions in a single system)
• Chronic disease risk identification (evaluation of risk factors, recommendations for  appropriate preventive services and screenings)
• Consistent recording of correct billing codes

But, adapting to Health Information Technology is a challenge.
• Health Information Technology almost always involves a “new system.” Consequently, the entire  staff, from health care providers to IM/IT personnel is on a learning curve.
• Existing IT infrastructure may not be adequate, so the Health Information Technology system  may be very slow, or may frequently crash.
• The new system may not have all the forms you need already in place. New forms may be needed.

Lessons learned from Health Information Technology implementation

Make use of as many training opportunities as possible.
• Learn as much as you can about the Health Information Technology that you need to use. Become  an expert.
• Ask questions if you are unsure how to navigate the system.

Keep the big picture in mind.
• Be aware that those keeping the Health Information Technology system up and running may have  a very different set of priorities. The IM/IT staff may not see your request as a priority when it is  taking all their manpower to trouble shoot the new system each day.
• Other changes to the Health Information Technology system may be in line in front of yours,  so be patient.

Think through changes thoroughly.
• Take time to think through a new form thoroughly. Know exactly what you want before talking  to the developer.
• Don’t think in a vacuum. If you build a form, make sure it is one your staff will use and  find efficient.
• Make a draft version of the form and use it before requesting that it be put into the new  system.
• Be prepared to build a good case for why your form should be created. Build a stronger case  if your form should be developed ahead of other requests in the queue.
• Be patient and persistent when working with a programmer/developer on a new form. Meet  frequently and set up timelines and deadlines.
• Coordinate with IM/IT and the Health Information Technology contractor to see if they can  support a new project in the necessary time frame.

For more information about Health Information Technology implementation, go to the Agency for  Healthcare Research and Quality (AHRQ) National Resource Center for Health Information Technology at  http://healthit.ahrq.gov.

To effectively manage your Company Health and Wellness Program resources, first determine the resources  you need and the resources you have. Then develop a plan to fill the resource gaps.

What Company Health and Wellness Program resources do you need?

• Make a list of staff members, materials, equipment, space, and logistical support.
• Be as specific as possible.
• Include partnerships that will be needed to make the Company Health and Wellness Program  happen.

Establish available Company Health and Wellness Program resources.

• Use materials that exist or are already on hand. Resist the temptation to start from scratch!
• Find out what other departments already have.
• Know where to borrow or get free materials.
• Use local or internal resources whenever possible.
• Look for opportunities to cut and/or share costs.

Develop a strategy to fill Company Health and Wellness Program resource gaps.

• Partner with as many staff members and corporations as you can. Stress what’s in it for them.
o Example: use a Physical Therapist to teach a back health class.
• Make use of community organizations and coalitions.
• Use volunteers as often as possible.
o Red Cross volunteers, medical interns or nursing students can supplement your  manpower.

Former Company Health and Wellness Program participants make good guest speakers.

• Keep a list of subject matter experts who will provide input for free so you can avoid the  expense of an outside contractor or consultant.

Look for innovative Company Health and Wellness Program opportunities.

• Other funding opportunities may exist at your facility.
o Example: if there is a book fair, see if you can apply to receive some of the  proceeds.
• Ask the unit to contribute resources to Employee Wellness Programs directly implemented at  the unit level.
• Get to know the contracting person at your company. They often know the least expensive  places to obtain many different kinds of materials.
• Look for “recycling” possibilities.
o Example: You may be able to give you old computer workstations for use with  electronic health assessments.

Good communication will help you find more partners and volunteers.

• Get the word out to the community about your Employee Wellness Programs.
• Describe what you are doing and how you are doing it.
• Presentation is everything. Keep information current and use lots of visual aids.

All Employee Wellness Programs require resources. Some resources you will already have. Some resources  you will have to find. Sometimes you will have to make something out of very little. Smart strategies  can maximize your Wellness resources.

Corporation processes are structured activities that achieve a specific result. For example, scheduling  appointments is a employer process that results in an orderly work flow and timely patient care.

Company Health and Wellness Program implementation often requires changes to established employer  processes. These changes may be simple, such as adding prescreening appointments to the scheduling  process, or more complicated, like determining how time devoted to a particular Company Health and  Wellness Program will be coded.

Not all change can be affected painlessly. However, developing a plan for achieving change will  overcome obstacles like:

“But we’ve always done it that way” or “But we’ve never done it that way.”

Each change situation will be different. The path to achieving change may not always be  straightforward.

Lesson learned: Making small, incremental changes will be easier than trying to make one big change. It  is also easier to modify a current process than to introduce a brand new one.

Develop a road map for change.

Describe the current employer process.
• For example: what is the current registration process for the weight management program?  Include steps for both participants and staff.

Establish where the new or modified employer process could fit into the current process.
• For example, prescreening appointments for the weight management program could be scheduled  when participants sign up OR the prescreening could be done at the first class.

Collaborate.
• Look at the change process to be a team effort. Determine everyone who will be affected by  the change and get their input.
o For example, be sure to ask the personnel that set up the prescreening appointments  AND the personnel that would do the prescreening for their ideas.
• Recruit one or more champions for the change. It helps if the champion has some clout.
• Get buy-in from as many staff members as you can – including those that might be most  resistant to the change.

Communicate.
• Don’t keep the change a secret. The more staff members know, the more likely they will  support a change.
• Anticipate obstacles ahead of time. Be ready to articulate concrete benefits that will result  from the change – especially advantages such as costs avoided or training time conserved.