CITY & COUNTY OF SAN FRANCISCO Wellness Plan Draft

CITY & COUNTY OF SAN FRANCISCO Wellness Plan Draft

The City & County of San Francisco Employee Wellness Plan is a collaborative initiative of the Mayor s Office, the Controller s Office, Health Service System and the Department of Human Resources.

TABLE OF CONTENTS Strategic Employee Wellness Plan The Value of Wellness...1 Health Risks and Costs...1 A Culture of Wellness...2 Wellness Plan Goals...3 Roles...4 Engaging Leaders and Building a Wellness Infrastructure 2014 Timeline...6 The Mayor...7 Health Service System...7 Department of Human Resources...8 Department Heads...9 Department Wellness Champions...10 Motivation Overview...12 Encouragement...13 Removing Barriers...14 Rewards...15 Recognition...15 Wellness Programs Overview...17 Awareness and Education...18 Programs...19 Environmental and Policy Change...22 Data, Evaluation and Reporting Overview...23 Data Sources...24 Evaluation...25 Reporting...26 Logistics Three-year Plan Highlights...28 [ DRAFT 06.05.14 ]

Strategic Employee Wellness Plan The Value of Wellness The City & County of San Francisco provides health insurance coverage for nearly 87,000 employees, retirees and family members. 1 Over the past three years, initiatives to improve quality of care and reduce insurance costs have focused on insurance purchasing and care delivery. These innovations, including the formation of two Accountable Care Organizations, flex-funding of the Blue Shield of California HMO, plan design changes, and assertive vendor management, reduced the projected cost of City s employee and retiree health insurance by $50 million. Bending the healthcare cost trend allowed the City to redirect those monies to civic programs and reduce the City s deficit. But business innovations alone cannot control costs in the long term. A comprehensive employee wellness strategy is an important component that will complement and support sound healthcare purchasing and vendor management strategies. Employees of the City & County of San Francisco keep our streets clean and neighborhoods safe, transport people via train and bus, maintain green spaces for recreation, provide healthy water to drink, ensure buildings are soundly constructed, care for the sick and injured, and so much more. The purpose of the City s wellness plan is to educate, inspire, and support employee wellness. Improving the wellness of City employees will enhance quality of life, improve morale, reduce worker injuries, reduce absenteeism, and help contain healthcare costs. This plan outlines a comprehensive and coordinated employee wellness strategy. (This plan does not address retiree wellness; a separate retiree wellness plan will be developed over the next three years. Although as the workforce ages and retires, healthy employees will become healthy retirees.) The City has unique characteristics that differentiate it from other large employers, highlighting the need for a comprehensive wellness strategy. The residents of the City depend on a healthy and resilient workforce to provide essential services every day, and in times of crisis. The average age of a City employee is 47. The choices made at this stage of life are a significant factor in determining whether an individual will enjoy many years of good health, or suffer from chronic and disabling conditions. City employees have almost twice the median length of service of municipal employees in the U.S. an average tenure of 13 years. 2 Spending this amount of time in City work environments has a significant impact on each individual s health and wellness. Approximately 40% of City employees, retirees, and family members live in San Francisco. Employee wellness is congruent with efforts to build healthy neighborhoods throughout the City. Health Risks and Costs As a starting point, Continuance Health Solutions provided the City with a high-level overview of costs associated with the health status of the City s employee population. This assessment included direct costs for group health insurance, sick pay, disability, and worker s compensation as well as indirect costs for productivityrelated losses associated with illness and injury. Continuance Health consultants estimated the total economic 1 In total the Health Service System (HSS) administers health benefits for over 110,000 employees, retirees and family members of the City & County of San Francisco, United School District, City College and Superior Court. 2 Per the federal Bureau of Labor Statistics the average tenure local government employees in 2006 was 6.6 years: bls.gov/news.release/tenure.t05.htm. According to the 2005-2006 Annual Workforce Analysis, the average tenure of a City employee is 13.1 years. sfdhr.org/modules/showdocument.aspx?documentid=1791. 1 06.05.14

impact associated with the health status of City employees, retirees, and family members at $716 million per year. This total is currently about 10 percent of the City s total budget. Excluding retirees, the economic impact for employees and family members was estimated to be $607 million. Roughly half of this amount, $324 million, was attributed to group health insurance costs. The other half was attributed to paid sick days, workers compensation, disability, and reduced productivity. In fiscal year 2011-12, City employees took an average of 12 days of paid sick, disability, and worker s compensation leave. This is ten percent higher than the national benchmark cited by Continuance Health Solutions. Additional benchmark data provided by Continuance Health Solutions suggested one-third of the City s lost work days may be attributable to 15 chronic conditions, and identified these top five health risks for the City employee population: CATEGORY CONDITIONS COMMON CAUSES cardio-metabolic cholesterol, diabetes, heart disease, obesity, physical inactivity blood pressure joint disorders arthritis, non-traumatic knee & back problems and intervertebral disc disorders occupational and non-occupational injuries, obesity, physical inactivity mental well-being depression, anxiety, chronic fatigue, sleep disorders, substance abuse stress, trauma, abuse, grief, chronic conditions respiratory allergies, asthma, respiratory smoking pain migraine, musculoskeletal and nerve physical inactivity, injury, pain ergonomics The Centers for Disease Control and Prevention (CDC) estimates that 70 to 80 percent of medical costs in the United States can be attributed to these types of chronic conditions. An effective wellness program can effectively educate and motivate individuals to make the lifestyle choices that can delay the onset, and reduce the incidence of these chronic conditions. Chronic conditions also have a negative impact on the number and type of medical services used, driving up insurance costs. For example, emergency room (ER) visits tend to be more frequent for individuals with conditions that are not well-managed. A recent report on Blue Shield of California members covered by the Health Service System (HSS) indicates the top three chronic conditions treated in the ER were asthma, migraine, and high blood pressure. Chronic conditions can be exacerbated or triggered by obesity, lack of exercise and chronic stress. Although the City currently has little data on employee health behaviors, a report on Kaiser Permanete subscribers covered by HSS indicated that 67 percent are overweight or obese, 37 percent have high total cholesterol, 8 percent have high blood pressure, and 12 percent smoke. A Culture of Wellness Work time, lunch time, and commuting time constitute over 50 percent of employees waking hours on a workday. Work environments, the social influence of managers and coworkers, and choices made during the workday such as what to eat for lunch and what to do on a break can have a significant impact on the health of each individual. Developing a culture of wellness will inspire and support healthy choices about exercise, nutrition, preventive care, stress management and emotional well-being. It will improve the health of today s employees, and also tomorrow s retirees. 2 06.05.14

A culture of wellness: Reminds employees about the importance of choosing healthy behaviors and provides information about how to do so. Provides opportunities to share experiences related to wellness among peers. Removes barriers, provides opportunities, and encourages employees to engage in healthy behaviors. Makes healthy choices popular and habitual. Although much time is spent at work, the importance of creating a culture of wellness in the home cannot be overlooked. Over time additional wellness strategies will include reaching family members, in order to help sustain healthy behaviors and decrease cost trends. Wellness Plan Goals The goals of this wellness plan are: Improve the quality of life and overall well-being of City employees, retirees, and their families. Improve health outcomes through prevention, managing risk, and properly managing conditions. Help manage rising costs of healthcare, worker s compensation, and disability as one part of a comprehensive strategy to control costs, so employer-sponsored health benefits are financially sustainable in the long term. The City s wellness plan has been designed to address our population s needs and is structured around the following four components: Leadership and Infrastructure Educate and inspire City leadership and managers to actively support a culture of wellness. Develop a network of department Wellness Champions. Align existing City resources, and put new resources in place as needed. Review policies and identify environmental changes to support wellness. Motivation Encourage participation through leadership support, communications, and peer-support. Remove barriers by offering accessible programs, providing discounts, and reviewing policies. Reward participation with prizes and incentives. Recognize participation, dedication, and success. 3 06.05.14

Programs Maintain and distribute annual wellness promotion calendar. Design and implement City-wide programs. Guide and support department Wellness Champions and programs. Operate the Health Service System Wellness Center. Maintain the wellness website component of myhss.org. Promote and support City and department policies that support wellness. Reporting Collect data from a variety of data sources. Evaluate participation and implementation on an ongoing basis. Report annually by department. Roles This wellness plan provides a structured approach for making the organizational changes needed to achieve the program s goals. The following lists an executive level summary of roles and responsibilities. Leadership support at all levels of the organization is needed to ensure the success of the wellness plan. The Mayor will: Publicly support a culture of wellness in the workplace Convene an Wellness Steering Committee committed to sustaining the wellness plan over the long term Set the expectation that department heads will support the wellness plan Review and approve a department wellness scorecard The Health Service System (HSS) will: Design and implement the Citywide wellness program Provide guidance and support to department Wellness Champions and Councils Track and evaluate wellness program success Present the annual wellness plan to the Wellness Steering Committee Department Heads will: Participate in the wellness plan kickoff and subsequent training Allocate staff and resources to support the wellness plan Be responsive to suggestions from the department Wellness Champion and Wellness Council Ensure department-level wellness programs align with department service objectives Take a leadership role in modeling healthy behaviors 4 06.05.14

The Department of Human Resources (DHR) will: Guide and support MOU and policy changes that will build a culture of wellness Develop strategies to improve leave management and reporting Participate in the Wellness Steering Committee Support communication efforts This wellness plan focuses on the roles and responsibilities of City employees at all levels in creating a culture of wellness. The role of labor leaders and labor organizations acting in partnership with the City to support wellness will also be an essential component in delivering on the promise of this wellness plan. As the role of Labor develops into formal commitments for supporting leadership, infrastructure, motivation and programs, this plan will be updated to incorporate those contributions. 5 06.05.14

Engaging Leaders and Building a Wellness Infrastructure Q1 Q2 Q3 Q4 HSS hires additional wellness staff HSS submits wellness plan to stakeholders Mayor holds leadership kickoff Champions attend training Citywide Well-Being Assessment (WBA) HSS submits budget proposal HSS presents wellness plan to Health Service Board Dept. heads identify Champions Champions form dept. Wellness Councils Leadership is the power of social influence, used to maximize the potential of employees, and achieve the goals defined by this plan. Innovation and operational support from senior management, including the Mayor, department heads, managers, DHR and HSS, will be required for this wellness plan to succeed. The support of labor leaders will also be key in building a culture of wellness for all City employees. 6 06.05.14

Engaging Leaders and Building a Wellness Infrastructure The Mayor and HSS will... Host a kickoff meeting for department heads and offer periodic training. To launch the wellness plan, HSS and the Mayor will host a kickoff for all department heads in the summer of 2014. The objectives of this event will be to Explain the value of a wellness program to the City, departments, and employees. Outline the key responsibilities of leaders in launching the program. Present the components of the program. Educate leaders about wellness and demonstrate the types of activities they may see in their departments over the coming years. In addition to the kickoff, HSS will provide department heads with concise program overviews, key talking points and suggestions on how to help promote upcoming wellness initiatives. These materials will be distributed before the launch of each City-wide wellness program. Throughout the course of the program, HSS will solicit leadership feedback on each department s needs and provide training and resources. Establish a Wellness Steering Committee. Early in fall 2014, HSS will work with the Mayor to create a Wellness Steering Committee, clarify expectations and identify potential Committee membership. Representatives from the Steering Committee, including representatives from the Mayor s Office, HSS, DHR, and the Controller s Office will meet semi-annually to review the annual wellness plan for the coming year, and review results reported about the previous year. Health Service System (HSS) will... Build a Wellness Division to implement the City s wellness plan. HSS will provide ongoing support to the departments in the form of an annual plan, training, resources, monitoring and reporting. A new Wellness Center opened in the spring of 2014 at 1145 Market Street houses the wellness division and serves as a location for some wellness services. The Wellness Manager, hired in December 2013, will focus on City-wide initiatives, such as the Well-being Assessment and wellness challenges, evaluate financial incentives, and develop the overall annual plan with the Wellness Steering Committee. The existing Health Promotion and Wellness Plan Coordinator, as well as an additional new Health Program Coordinator III who came on board in April 2014, will support the departments as they develop their wellness initiatives. An additional Health Program Coordinator III has been requested in the 2014-15 budget to enhance support for departments. Having three Coordinators increases the ability to provide individualized feedback to departments and is the minimum staffing necessary to roll out and support such a large initiative. A Management Assistant is expected to join the team in June 2014. This position will provide administrative support to the existing team and help manage the new Wellness Center. The existing two Employee Assistance Program (EAP) counselors will continue to provide individual and group services to promote mental and emotional well-being. A third EAP counselor has been requested in the 2015-16 budget to expand the team s ability to provide organizational wellness support, such as mediation, management consultation, and management training on behavioral health in the workplace. EAP also provides group workshops on mental health issues such as anger management, depression in the workplace, overcoming 7 06.05.14

anxiety, bullying in the workplace, communication and conflict resolution, parenting, stress management, and dealing with difficult people. A larger team will facilitate development and evaluation of tailored interventions specific to City employees and departments. Identify wellness program budget and funding strategies. HSS will work with the Controller s Office and the Mayor s Office to develop a three-year budget for the wellness plan. The budget will include costs for HSS staffing, communications, wellness programming and data analysis needed to implement the wellness plan. Funding strategies will be determined, including use of existing resources, such as programs currently provided by contracted health plans and other City departments. HSS will conduct a needs assessment to identify departments that do not currently offer wellness programs and assess any additional needs for resources. Offer ongoing training to department heads, Champions, and managers and supervisors. Starting with the Mayor s kickoff in the summer 2014, HSS will provide training as necessary to promote the success of the wellness plan. Following the leadership training, in the summer 2014, HSS will provide initial training to Champions about their role and upcoming City-wide initiatives. Starting in 2015, these trainings will be offered at least quarterly. Additionally, HSS will expand training efforts to reach managers and supervisors. Although senior leadership opens the door to a culture of wellness, it is the day-to-day, on the ground management and supervisors who communicate the vision to employees. Similar to senior leadership, managers and supervisors will receive training and be recognized for program success. HSS will work with departments and DHR to investigate specific avenues for training managers and supervisors in supporting wellness activities. Department heads will be responsible for holding managers and supervisors accountable. Collaborate with the City Attorney and to review legal considerations. HSS will work with the City Attorney to review legal issues related to specific wellness plan offerings. It is important to define any legal considerations in offering wellness programming, such as location and space requirements, access issues, liability concerns, and compliance with the Affordable Care Act and Americans with Disabilities Act. The City Attorney will develop the appropriate strategies to address all legal concerns, including drafting waivers for participation in some wellness activities, as appropriate. Review current communication channels and identify opportunities for improvement. Communications will play a key role in the wellness program education and participation. HSS will work with departments to capitalize on existing infrastructure. Digital channels are far less costly to use than paper mail and can be highly effective, but HSS does not currently have the ability to reach all employees via electronic means. Effective wellness programs require a multitude of communications channels. Department of Human Resources (DHR) will... Review City-wide policies and training programs related to wellness. Annually, DHR will inventory, review and revise policies as needed to help promote wellness. DHR and HSS will explore opportunities to coordinate injury and illness prevention and return to work programs with wellness information and resources. DHR and HSS can also explore the opportunity of providing joint trainings to managers that address specifics of the wellness plan, and help managers develop supervisory skills that support employee wellness, engagement and motivation. 8 06.05.14

Collaborate with Labor on member engagement and program rollout. Labor plays a key role in promoting the health and wellness of their members. DHR s leadership in collaborating with Labor and reviewing policies that support wellness will be fundamental in engaging members and supporting a culture of wellness. Through the Joint Labor Management Committee on Health and Wellness (JLMCHW), labor, DHR, and HSS will collaborate to ensure successful rollout of the wellness plan to members. HSS will provide resources as requested, such as communication materials developed to help spread information and encourage participation. Distribute communication materials such as posters and flyers. To assure that communications reach employees a variety of communication and distribution tactics will be necessary. Onsite human resource professionals will assist in posting materials provided by HSS. Department Heads will... Embrace and support the wellness plan. At the direction of the Mayor, department heads will support a culture of workplace wellness for the City, including: Participating in the wellness program kickoff and periodic leadership training. Identifying a supportive and engaged department Champion to lead wellness efforts and develop a department-specific plan. Providing continued support to the department s Wellness Champion and Wellness Council(s). Conveying the value of wellness to managers and supervisors, garnering their support in spreading the word to employees. Identifying communication channels best suited to reach employees. Ensuring department-level wellness programs align with department service objectives. As Champions review initiatives for the department, they will need leadership review, approval and support for initiatives. Reviewing and adopting department policies that support wellness in the workplace. Striving to meet or exceed annual wellness criteria outlined in the department scorecards. Leading by example and modeling healthy behaviors. Identify a Department Wellness Champion(s). After the leadership kickoff, the department head will identify a Champion. The Champion is a volunteer or designee selected by the department to build the department wellness structure and promote wellness efforts for the department. Large departments or those with employees dispersed throughout several locations should consider multiple Champions. Leaders should consider the department s existing infrastructure when determining the appropriate number of Champions. As a starting point, HSS recommends considering a ratio of 1:300 employees or one Champion per location. The Champion is the department s wellness liaison coordinating with both HSS and the department head. HSS will help outline the roles and responsibilities of this position to assist department heads in identifying potential candidates. It is expected that this person have at least four and preferably eight hours or more dedicated to wellness each month. In larger departments, this role may grow into a larger portion of the individual s job responsibilities. Champions will need to model healthy behaviors, promote programs, maintain enthusiasm, and enlist support throughout the department for participation. Engagement in collaborative Champion trainings will be essential to build Champion skills, share knowledge and inspire and support other Champions. 9 06.05.14

Strive to achieve the criteria set forth in the annual Department Scorecard. The Mayor added a wellness objective to department head performance plans in Fiscal Year 2013-14. The objective states that the leaders will encourage and promote wellness activities and a culture of wellness throughout their departments. The Mayor will use department scorecards that set annual criteria for department-level participation to evaluate performance. Annual criteria will be set based on program goals and will take into account associated incentives, importance, and experience from the previous year. The following provides an example scorecard. YEAR ONE YEAR TWO YEAR THREE Annual Leadership Training Goal: Department head attends Annual Leadership Training Goal: Department head attends Annual Leadership Training Goal: Department head attends Well-being Assessment Employee Participation Goal > 40% Department Wellness Champion Goal: assigned and attends collaborative training sessions Well-being Assessment Employee Participation Goal > 50% Department Wellness Council Goal: council formed and submits annual plan to HSS by end of Q1 City-wide Wellness Challenge Staff Participation Goal >20% Department Wellness Champion completes the four Department Wellness Program Surveys Goal 100% Manager and Supervisor Training Participation Goal > 50% Well-being Assessment Employee Participation Goal > 60% Department Wellness Council Goal: Healthy Worksite Recognition City-wide Wellness Challenge Staff Participation Goal >20% Department Wellness Champion completes the four Department Wellness Program Surveys Goal 100% Manager and Supervisor Training Participation Goal > 50% Department Wellness Champions will... Attend training provided by HSS. HSS will host, at a minimum, quarterly collaborative Champion training starting in the summer of 2014. During these sessions, HSS will provide training on upcoming City-wide programs and outline the role of the Champions in promoting wellness activities. One of the strongest communication channels within the City is onthe-ground, department-level, peer-to-peer distribution. Champions will be trained so they can effectively use branding, templates and messages provided, including how to customize, display and distribute. In addition, based on quarterly themes, HSS will present toolkits, resources, and materials to help the departments address awareness and education, programs, and environmental and policy changes. Training will address increasing awareness, promoting activities, leveraging existing resources and free services, implementing policy and environmental changes. Champions will share ideas and participate in data collection, reporting, communications, wellness programming, policies and environmental changes, and strategies to encourage participation. At the end of each quarter, Champions will be required to complete the Department Wellness Program Survey to provide feedback on the resources and the results of their implementation. This will help HSS continuously improve resources and measure participation and success. 10 06.05.14

Develop a department-specific Wellness Council. The Champion will need to work closely with department leadership to develop a department Wellness Council or councils. The Wellness Council is comprised of employees representative of the department who are enthusiastic about wellness and work together to promote wellness at the worksite by providing education, offering programs and addressing environmental changes. Wellness Councils will need to be in place by the beginning of 2015. Larger departments may consider having multiple councils, to represent different locations. Smaller departments, specifically those that share a location, may consider having joint councils. The final structure is the decision of the department, but HSS is available to consult on the best structure and offers a Wellness Council Toolkit. 11 06.05.14

Motivation Engaging Employees in Wellness ENCOURAGE REMOVE BARRIERS RECOGNIZE REWARD Onsite wellness programming Wellness program and product discounts Policies that promote wellness Leadership support Persuasive communications Programs that foster peer-to-peer support Financial incentives Prizes Giveaways Mayor s annual wellness awards Success stories Praise Motivating change, especially behavior change requires a varied approach that includes removing barriers, encouraging, rewarding, and recognizing participation and improvement. The wellness plan offers a diverse strategy related to motivation that ranges from financial incentives to peer support to annual awards. 12 06.05.14

Motivation Engaging Employees in Wellness Encouragement Department heads will actively demonstrate support for wellness programs. The department head will demonstrate an active commitment to wellness that is visible to employees. This could include providing messages of support, attending department wellness events, encouraging and facilitating employee participation in wellness activities, providing department-level recognition for wellness program participants and adding the wellness plan brand to email signatures. Creative ways to demonstrate support include publicly weighing in for a weight challenge, leading a group walk, sharing their personal story and asking employees to act. These activities encourage people to talk about wellness activities and encourage participation. HSS will provide training and checklists to leaders about informal ways that a leader can demonstrate a personal commitment to wellness. Innovation awards will be offered to the leader and department that shows creativity in promoting wellness. HSS will offer City-wide challenges to promote peer support and healthy competition. Challenges are typically six to ten weeks in duration and encourage a specific behavior change. Many challenge platforms include features, such as the creation of teams, message boards, leader boards, and other social networking opportunities to generate peer support and competition. Challenges with or without social networking platforms also motivate by creating a common goal and encouraging interaction among coworkers related to wellness. HSS will provide ideas and materials for mini-challenges that can be implemented by the individual departments through their Champions. Champions will leverage peer support. Peer support drives initial engagement and continued success. For example, a department begins to host an optional weekly salad day where employees are encouraged to bring in one ingredient for a group salad lunch. These social events lead to employees sharing other healthy recipes and supporting each other in healthier lunch choices not only on salad day but everyday. Other employees hear about salad day and more join in. Over time, a culture that promotes healthy lunches takes hold as the social norm. Programs that include peer support tend to be more sustainable as peer support acts a long-term motivator. Another example of a department-level initiative that uses peer support is a walking buddy program. HSS will provide training and materials to help Champions develop department-level initiatives that leverage peer support. HSS will develop a brand and engaging communications to support the wellness plan. Effective program communications can help foster a positive work culture in which employees on all levels embrace wellness. In turn, a healthy workplace culture will facilitate an open exchange of ideas that drive wellness programming forward. The best way to earn employees attention is with timely, relevant content that has a call to action, is published at consistent intervals, and invites audience feedback. HSS will take the lead in developing a wellness program brand as well as supporting communication materials for City-wide programs, such flyers, posters, signage, enews, and a new wellness section on the HSS website. HSS will also collaborate on content distribution with Champions and other employees who manage departmental intranets, break room postings and email announcements. 13 06.05.14

Removing Barriers HSS and Champions will expand onsite programs. Improving access to fresh foods, providing spaces to be active, and offering health education lunch and learns are all ways workplaces can lower barriers for employees. The programs section of this plan addresses specific onsite programming in more detail. During the Champion trainings, HSS will introduce new resources and teach new skills that facilitate the Champion and the Wellness Council s ability to offer more services to employees at the departments. HSS will expand discounts to a broad range of wellness services. Currently, HSS offers several fitness center discounts and provides reduced rates for Weight Watchers at Work. In 2014, HSS will pursue expanding discounted services to address more areas of wellness such as nutrition and stress management. If there is department interest in a particular discount, please contact HSS to explore the discount for all City employees. HSS will expand the wellness portion of the myhss.org website. Employee feedback suggested that there should be one central location for wellness information. HSS will enhance the existing website to house information about the various wellness programs offered throughout the City, including resources offered through the health plans as well as resources for leaders and Champions. In 2014, HSS will enhance the website to facilitate employee participation in City-wide initiatives. Over the long term, HSS will design a member experience that guides employees to the activities best for them. Department Champions will need to provide information to HSS including success stories, quarterly implementation feedback, and announcements of upcoming events to include on the website. The revamped website can serve as a database of digital tools and resources that employees can access as their schedules permit. DHR will outline what time can be used for wellness activities. In consultation with the Executive Officer of the Civil Service Commission, DHR will issue a written clarification to departments and employees that sick leave is appropriately used for care and consultation with medical providers including, but not limited to, biometric screenings, flu shots and other preventive care and assessments. DHR will collaborate with the Controller s Office and will issue specific instructions including the leave code to be used. Departments will consider alternative work schedules. DHR will issue a policy encouraging departments to allow adjusted work schedules, where operationally feasible, to facilitate the ability of employees to participate in exercise programs in conjunction with the workday. These arrangements could include allowing later or earlier starting and ending times, or longer lunches, with adjustments to start or end times to make up time. The policy will also include a reminder that floating holidays, vacation, and compensatory time off are available for these purposes as well. 14 06.05.14

Rewards HSS will investigate options for developing a financial incentive program. Over the course of the program, any monetary incentives will transition from activities that only identify wellbeing to activities that will improve wellness (participating in smoking cessation classes; increasing physical activity). HSS and departments will consider participation-based rewards. Non-financial rewards for participation can be as effective as financial incentives if the reward is valued by the participants. Participation-based rewards can help nudge potential participants who are on the fence. They can also get people talking about the program. Instead of providing everyone who participates in a challenge with a dollar amount, HSS will consider various merchandise as rewards. An example would be providing a physical activity tracking device to all members who register for or complete a challenge. With advanced technology these devices have become more sophisticated and may even motivate in the absence of or after a challenge. Departments should consider providing lower-cost participation-based rewards to complement any incentives or rewards offered by HSS for Citywide programs. For example, departments can provide everyone who joins the department walking group with a water bottle. HSS and departments will offer prizes. HSS may offer prizes for participation in a survey, focus group, or for attending an HSS event. Departments should consider prizes for department-specific events and programs. Much like encouragement from leaders, prizes get people talking. When people are talking about wellness activities more people will know about them and therefore more people are likely to participate. Prizes differ from participation-based rewards in that not everyone will receive a prize. Prizes, such as a gift card, are usually based on a random drawing of entries among participants. When providing prizes as part of a wellness program, it is important that the prizes encourage continued healthy behaviors and avoid sending a mixed message. HSS will provide recommendations for prizes at a variety of pricepoints for department-specific initiatives and follow those recommendations for City-wide initiatives. Examples of participation-based rewards Water bottles $5 gift cards Stress balls Fruit/healthy snacks Hand sanitizer Examples of wellness-related prizes Bicycle Gift card for massage Fruit basket Ipad filled with health apps Sports watch Digital fitness tracker Recognition The Mayor will present annual wellness awards. The awards will provide formal annual recognition of progress and success. The Mayor will host a healthy breakfast to recognize winners from the success story competition, announce departments that received healthy worksite awards, and will recognize innovative and engaged leaders and departments. 15 06.05.14

Department Champions and leaders will provide opportunities for recognition. Recognition is powerful, whether it comes from supervisors or peers. (One study found that workers who received a meaningful two-sentence thank you message from a supervisor were 50 percent more productive than those who did not.) To encourage wellness program participants, especially early adopters, as well as engage other employees, recognition mechanisms will be an essential component of communications. HSS will provide the departments ideas for recognition during trainings. Myhss.org will be used for recognition. HSS will dedicate a portion of the HSS website to highlight individual success stories, report participation statistics, acknowledge creative and supportive leaders, and provide information about the work of department Champions and Councils. INDIVIDUALS MAYOR S ANNUAL AWARDS DEPARTMENT RECOGNITION HSS WEBSITE Healthy breakfast with the Wellness wall where success Monthly success stories Mayor for annual success story stories are posted competition winners Periodic pot luck healthy breakfast or lunch for program participants and volunteers Congratulations cards and certificates Online competition; vote for your favorite success story Quotes from department program participants DEPARTMENTS Announce departments that receive healthy worksite award Mayor s awards for most innovative, most improved, and other categories, with a department wellness gift Friendly competition rankings vs. other departments Display of department population health statistics, showing improvement over time Participation statistics by department Photos and highlights of activities being offered by departments LEADERSHIP Recognition of department leaders who meet or exceed wellness scorecard criteria Healthiest manager in the department recognition, voted by employees Photos of City leaders and department heads participating in wellness activities 16 06.05.14

Wellness Programs AWARENESS AND EDUCATION City-wide HSS will... Develop wellness campaigns Provide an annual wellness calendar to coordinate wellness education across the City Provide training and resources for Department Wellness Champions and Wellness Councils Department Wellness Champions will... Set a positive example by modeling healthy behaviors Distribute awareness materials provided by HSS Use the annual wellness calendar and resources provided to coordinate Departmental educational presentations, demonstrations, and activities PROGRAMS City-wide HSS will... Offer one Well-being Assessment to all employees Coordinate City-wide contracts to offer biometric screenings and flu shot clinics onsite Offer City-wide challenges to promote healthy behaviors Provide training and resources to help Champions expand onsite programming Explore expanding wellness services through the health plans and EAP Pilot wellness coaching and research this as an ongoing service Open a new Wellness Center where fitness classes, wellness courses, wellness coaching, and presentations will be available Department Heads and Champions will... Strongly encourage participation in the WBA Identify space for wellness activities Coordinate onsite biometric screenings and flu shot clinics Champions and Wellness Councils will... Coordinate onsite fitness classes, wellness courses, and presentations with the support of HSS ENVIRONMENTAL AND POLICY CHANGES City-wide HSS will... Provide training and resources for departments to explore environmental and policy changes Investigate healthy worksite recognition programs and train Champions on achieving the awards City-wide DHR will... Consider any City-wide policy changes Evaluate training opportunities Department Heads will... Review DHR and department wellness policies and communicate to employees Review proposals from Champions/Wellness Councils for environmental or policy changes Ensure safety policies are in place and enforced Champions and Wellness Councils will... Raise awareness about wellness policies Assist in implementation of policy changes 17 06.05.14

Wellness Programs This plan builds on employee wellness initiatives that have already started in several City departments. As of 2013, several City departments have developed Wellness Councils. Worksite flu shot clinics have immunized 3,652 individuals at 17 locations, and 1,159 individuals have received biometric screenings. Some departments have started offering group exercise classes, health fairs, health education classes, and Weight Watchers. It is time for these programs to exist across the City, be offered consistently, and be complemented by education and resources to support individual change. These existing initiatives provide a strong foundation and valuable lessons learned that will help facilitate the adoption and launch of a City-wide employee wellness plan. Awareness and Education HSS and Champions will use the annual wellness calendar to plan activities. The following approach offers four health behaviors to focus on (one each quarter). This allows for longer programming efforts. Here is an example of themes for one year: PREVENTION July October NUTRITION November December Well-being Assessment PEACE OF MIND January March Campaign to communicate behavioral health benefits and resources Biometric screenings MOVEMENT April June Examples of City-wide Initiatives Flu Shot Clinics Open Enrollment Shape Up Walking Challenge Examples of Department Initiatives (supported with HSS resources) Heart health lunch and learns Smart patient educational materials Maximize your benefits lunch and learns Healthy holiday recipe swaps Dept. pledge: no sugary treats Less is More for the holidays presentation Weight Watchers at Work Promote employee success stories Dept. pledge: more thank yous in the workplace Meditation demonstrations and stress reduction classes Dept. walking paths Walking clubs Staying fit with a chronic condition presentation Zumba classes Relevant National Health Observances, such as American Heart Month, American DiabeteMonth, the Great American Smokeout and National Physical Fitness Month, will also be promoted to align with City employee wellness initiatives. The calendar focuses on major and preventable health risks to align communication and programming efforts across the City throughout the year. Aligning efforts with relevant National Health Observances increases the odds that messages seen at work will be reinforced by messages on television and local event planning. Quarterly themes will be selected based on available data, expressed needs by Wellness Councils and leaders, and the ability to affect positive change in the workplace. The creation of an annual wellness calendar will unite the various departments while allowing departments to choose the programming, policy and environmental change options most suitable to them. HSS will provide resources and tool kits to the Champions that support both the quarterly themes and monthly themes as appropriate. 18 06.05.14

Champions will provide awareness materials and educational programming. To support the annual wellness calendar topics, national health observances, and information about health benefits, HSS will provide Champions with educational materials for distribution through the departments. To increase the impact of educational efforts, HSS will also provide suggested strategies for promoting and sharing this information, and research and provide local speaking contacts that departments can draw upon for onsite lunch and learns and workshops. To assure that communications reach employees, onsite human resource professionals will assist in posting materials provided by HSS. Examples of Champion-led awareness and education Take the stairs campaign How much sugar is in your drink? demonstration Work stress de-compress Annual wellness exam campaign Programs HSS will offer the Well-being Assessment to all City employees. Currently, the three health plans offer three different online health risk assessments (HRA). However, inconsistency in the data collected and low participation rates reduce the value of these existing offerings. After reviewing the current offerings, HSS has decided to offer the Well-being Assessment (WBA) to all employees starting in late 2014. The WBA is a questionnaire that gathers self-reported health information to determine current health-related behaviors, attitudes, and overall well-being. The WBA will inform employees about the health impacts of their lifestyle choices, and is used as a tool to help employees develop a targeted health improvement strategy. HSS will also develop a promotional strategy to encourage participation, and help people make the most of their WBA results. All individual results for the WBA are completely confidential. HSS will be able to use aggregate results to track the impact of the wellness plan and the overall well-being of employees. Department leaders and Champions can support WBA participation by taking the assessment and using department-specific communication channels to spread the word. The WBA comes with an optional interactive online program called the Daily Challenge (DC). The Daily Challenge suggests one small healthy behavior each day via email. If the individual completes the challenge and records it, he/she will earn points on the social networking platform. Periodically, the platform will recalculate the well-being score showing the participant how making small changes can improve overall wellness. HSS will collaborate with Champions to offer biometric screenings at the departments. HSS will collaborate with department Champions to offer biometric screenings onsite for all departments in 2015. HSS will use these screenings to engage individuals in their own health, communicate the value of preventive care, and encourage an active relationship with their treating physician. In the past, HSS has provided mobile biometric screenings at a handful of City departments and locations. In contrast to the Wellbeing Assessment, a screening provides objectives measures of cholesterol, blood sugar, blood pressure and body mass index. Biometric screenings provide valuable and immediate feedback to employees about their cardiovascular risk factors. Upon completion of the biometric screening, the employee receives an immediate review of all results and recommendations for improvement. Screening events are an excellent opportunity to make employees aware of programs and benefits that are personally relevant and beneficial. Department leaders and Champions can support biometric screening participation by attending the screening, reminding employees they can use sick time and using department-specific communication channels to spread the word. To coordinate the screenings, Champions will need to decide if it is appropriate to partner with another colocated department to maximize resources, or if multiple screenings will be needed at multiple locations. 19 06.05.14

HSS will collaborate with Champions to host onsite flu shot clinics at the departments. HSS will collaborate with department Champions to offer onsite flu shot clinics for interested departments annually. Onsite flu clinics increase immunization rates by increasing convenience. Onsite flu shot clinics are free for employees but quantities are limited. HSS will administer City-wide wellness challenges. HSS will administer one or two City-wide challenges annually. Challenges are typically six to ten weeks in duration and encourage a specific behavior change. Wellness challenges require careful crafting to remain aligned with evidence-based recommendations and engage higher risk individuals. For example, a weight loss challenge may encourage participants to lose a significant amount of weight in a short period of time, inadvertently promoting unhealthy eating habits that are unsustainable. If a physical activity challenge rewards individuals for logging the most steps in the shortest time, it will dissuade less active employees from participating. Because they are offered to the entire population, challenges typically focus on promoting behaviors that are beneficial to the general population, such as healthy eating, physical activity, weight management, and stress management. HSS will work to align new City-wide challenges with the existing annual Shape Up San Francisco Walking Challenge. Department leaders and Champions can support challenge participation by registering or starting a team, using department-specific communication channels to spread the word, implementing complementary programming like a walking group during a physical activity challenge, hosting a kickoff, and offering prizes to those who register for the challenge by a specific date. HSS opened a new Wellness Center. On May 19, 2014 HSS kicked off a week of grand opening events at the new Wellness Center located on the first floor of 1145 Market Street. The facility provides City employees with a central location to contact, learn about, and make the most of, wellness benefits. While most wellness activities will take place at work locations throughout the City, the HSS Wellness Center is the central hub for information and coordination of City-wide employee wellness programs. The Center houses the HSS Wellness Division, including EAP, and offers diverse programming including fitness classes and educational workshops. HSS provides an Employee Assistance Program (EAP). Currently, EAP offers voluntary, confidential, no cost brief solution-focused counseling and information program for employees and their family members. EAP staff at HSS are licensed psychotherapists who provide assessment, short-term therapy (up to six sessions), referrals and follow-up for individuals, couples, families and groups regarding personal or work-related issues such as stress, marital conflicts, family and relationship problems, anger management, substance abuse, work performance issues, emotional difficulties, and any concern that becomes a problem in one s life. EAP staff offer consultation to City supervisors, managers, and human resource professionals.the EAP staff is also available for mediation/conflict resolution sessions, workplace violence prevention and Critical Incident Stress Debriefings following a traumatic event. HSS and departments will offer fitness and wellness classes. HSS has partnered with the Department of Recreation and Parks to offer fitness classes at the Wellness Center at no cost to employees. HSS will partner with the Department of Recreation and Parks (REC) to determine the best promotion of those opportunities to extend the reach of wellness from the Wellness Center throughout the entire City. Champions will report back on classes offered, participation, and satisfaction as applicable on the periodic Department Wellness Program Surveys (see Data, Evaluation, and Reporting section for details). HSS offers a variety of wellness classes at the Wellness Center and will assist any departments interested in offering wellness classes onsite. HSS is also considering offering more targeted and extended courses, such as the Diabetes Prevention Program for individuals with pre-diabetes. HSS will be collecting employee feedback 20 06.05.14