Presentation Transcript

1. Generating & Measuring Healthy Workplace OutcomesHealth Work & Wellness ConferenceSeptember 30, 2010Peter Melnyk PhD & Allan Smofsky

2. Agenda 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 Employer survey: Focus on Canadian employers New/emerging strategies where are we now? where are we going?
3. 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
4. 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
5. Methods 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 key search terms screening abstracts full text screening data extraction PubMed
6. General Results I benefit costs1 disease categories other these conditions are preventable or modifiable through behavioural changes cardiovascular, musculoskeletal, respiratory, digestive, cancer, stress. 70% the Canadian WHP programs identified primarily targeted: cardiovascular health, general health, musculoskeletal disorders disease management – absent from the peer reviewed literature.. 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
7. General Results II Key factors that contribute to successful WHP initiatives are: Targeting several health issues Attaining high participation Successful WH Strategy Integration of occupational health and safety with workplace wellness: enhanced effectiveness employee receptivity time & access . on-site services incentives `` Integrating WHP into the organization’s culture and operations
8. Workplace Wellness Programs in Canada 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) 91% offer some type of wellness initiative 44% 1997 2009 2. Buffet and Company. 2009 Wellness Survey.,3. Stewart N. The Conference Board of Canada, 2010
9. Workplace Wellness Programs in Canada 2010 Conference Board of Canada Survey (N=255):3 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… 3. Stewart N. The Conference Board of Canada, 2010
10. Components of WHP programs offered in Canada 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 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
11. Program evaluation I 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 productive employee health not consistently managed or monitored by health professionals human resources professionals may not receive training necessary to interpret and manage employee health and wellness resources/tools available 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
12. Program evaluation II 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 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.
13. Evaluation metrics 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?
14. 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
15. Supportive Organizational / Work Culture Personal Health/Lifestyle Practices Healthy, Productive, Successful Workplaces Safe & Healthy Work Environment Defining a Healthy Workplace – current (Canada)
16. 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
17. Defining a Healthy Workplace- new Leadership Engagement Employee Involvement Mobilize Assemble Improve Healthy, Productive, Successful Workplaces Evaluate Assess Do Prioritize Plan Adapted from World Health Organization, 2010
18. Defining a Healthy Workplace 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
19. Defining a Healthy Workplace 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 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
20. Defining a Healthy Workplace Job Satisfaction  > Job Stress  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 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
21. Defining a Healthy Workplace 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 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 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 ¹¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010
22. 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 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 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
23. Healthy Workplace – Who Cares?
24. Measuring outcomes
25. Healthy Workplace Outcomes Measurement- Guiding Principles Understand your organization’s key issues & cost drivers that impact employee health/well-being Determine key benchmark measures & establish baseline Include qualitative measures (e.g. how employees say they manage their health) as well as quantitative Consider both lagging and leading indicators Determine desired objectives/outcomes; establish linkages between outcomes where possible at outset & factor into evaluation methodology Evaluate at identified milestones on an ongoing basis Standardize and align data requirements across all relevant vendors where possible Compare where possible to relevant norms – Canadian, industry specific, etc. 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
26. 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
27. 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
28. Population Health Trends 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? 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
29. 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 Canada2007 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
30. (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
31. Workplace Health & Well-Being – an Outcomes Framework Safe & Healthy Work Environment Business Metrics - Productivity - Customer satisfaction / loyalty - Financial performance “Health” Metrics Absenteeism / Presenteeism Attraction / Retention - Health benefits cost Physical Work Environment Health & Safety Process Health & Safety Culture Physical Health Musculoskeletal Energy Safety performance Working Relationships Awareness/ prevention Supportive Psychosocial Work Environment Personal Health/Lifestyle Resources Employee health/ well-being Risk identification tools/ targeted support Leadership/ Manager Effectiveness Social Health Trust Fairness Connectedness Psychological Health Stress Overall health Control Employee involvement in CSR Corporate Social Responsibility Personal Growth & Aspiration
32. Linking drug and disability data -an example of a broader outcomes approach 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 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
33. GENERATING OUTCOMES
34. Workplace Health & Well-being – A Continuum & Planning Framework Well E.g., low risk, good nutrition, active lifestyle At Risk E.g., inactivity, high stress, overweight, high blood pressure, smoker Chronic Conditions E.g., prevalent diseases and chronic conditions Acute Conditions E.g., respiratory, strain and sprains, lacerations Catastrophic Conditions E.g., severe burns, premature infant, head injury Opportunities for Integrated Prevention/Care Management Interventions Health Promotion Health Risk Management Disease Management Self/Professional Care Case Management Community-based programs (awareness/prevention) Targeted health risk assessment Patient identification and enrollment Self-care triage tool Utilization management Immunizations Targeted behavior modification (e.g. health coaching) Behavioral and clinical support Telephonic//E-consults/Clinician visit Disease-specific Case management Health Screening- HRA & biometrics Stress/mental health management Care coordination Post- decision support Care coordination Health information resources Community-based programs (risk-specific) Address co-morbid conditions Occupational health and safety Social support “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 34
35. 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
36. CWH Implementation Process Take Stock Take Action Evaluate 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 Take Action: Develop a healthy workplace strategy and implement a plan to best address the needs and gaps identified in taking stockphase Plan: Set goal and identify programs, processes or policies needed; develop action plan Act: Implement action plan Evaluate: Evaluateoutcomes 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
37. 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
38. 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
39. 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
40. Next Steps- Employer Survey 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”
41. 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/
42. you can take more than one session to complete the survey; remember to Save before Logging Out when you have completed the survey, check SurveyCompleted, click Save, and then Logout
43. Survey – early returns 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
44. 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: peter_melnyk@biomedcom.org asmofsky@cogeco.ca