Promoting good health at the workplace began taking root in America more than two decades ago as a few innovative employers pioneered health promotion and introduced convenient, onsite health clinics. Now, in response to ongoing concerns about health, escalating health care costs, productivity, and lack of access to primary care, many employers are incorporating or expanding onsite clinics. They reason that onsite health care can improve employee health, which in turn can increase employee productivity.
Obtaining optimal results
A recent Joint Consensus Statement offers several elements of a reasonably designed wellness program including: Strategic Planning, Cultural Support and Programs, which should include:
- Assessment and Screening
- Behavior Change Interventions
- Engagement Methods
- Measurement and Evaluation
The missing ingredient in the joint consensus statement is the need for sustainable population-based behavior change. The internationally recognized health behavior organization Pro-Change Behavior Systems and its worksite health care partner Healthstat provide the following guidance within each of these four areas as the only real means to achieving cost and productivity goals.
1. Assessment and screening: Most health assessments identify self-reported health risks, but few also use validated questions to identify a persons readiness to change. Knowing this ensures that employers are not limited to providing one-size-fits-all information and education. Healthstat believes best-in-class programs integrate risk and readiness to change information into an electronic health record (EHR) or similar software platform. Clinical staff trained in the Transtheoretical Model of health behavior change can then leverage the information to engage more effectively with their patients.
2. Behavior change intervention: Onsite centers are increasingly recognized as far more than treatment centers. In describing the next generation of onsite clinics, Spero reported that the role of clinics includes year-round wellness programs to modify lifestyle risks with clinicians trained as health coaches. In this scenario, onsite clinics represent an ideal channel to offer engaging programs that help the healthy stay healthy, promote change for those with health risks, and act as an adjunct medical home.
3. Engagement methods: Successful workplace programs engage more participants by offering multiple, integrated delivery channels, such as web portal, health coaching, etc. Engagement can begin with tailored feedback immediately after the health assessment. This can be accomplished in print or online health assessment administration. Clinicians may then utilize tools accessible in the EHR (e.g., clinical dashboards) to deliver brief, evidence-based behavior change messages during any interaction with the patient. The tools also enable the clinician to prescribe appropriate behavior change interventions and quickly check on participation and progress at subsequent interactions with the patient.
Given the ubiquity and convenience of mobile devices, all online programs should be mobile-optimized. SMS messaging may be leveraged to increase engagement and retention in lifestyle management programs. However, the text messages need to serve as more than reminders. A 2012 study showed meaningful enhancements to engagement and outcomes when individually tailored text messages were added to an already effective best-practice online smoking cessation intervention.
4. Measurement and evaluation: The best programs collect more than participation and retention data; they measure improvement in population biometric scores and improvements in behavior change outcomes. They also track productivity (absenteeism, presenteeism, output per employee) and well-being scores. Systematic program evaluation can inform program enhancements.
Conclusion
Employers are not the only institution, but arguably the best institution in America with the influence to channel and change peoples health behaviors. But only those organizations that embrace the full concept of wellness by implementing programs like described here have the ability to improve the physical health of their employees and put corporate productivity and profitability back in the black.
John Kaegi is the chief strategist for Healthstat Inc. and Sara Johnson is senior vice president of research and product development for Pro-Change Behavior Systems Inc.
