This is an excerpt from Winning Health Promotion Strategies by Anne Marie Ludovici-Connolly.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.