Workplace Wellness Programs: Focus on Company and Employee Wellbeing Julie Parkes Bachelor of Science in Sports Management, Wellness and Fitness Concentration Department of Exercise Science and Sport Studies FIT 430 Dr. Hess California University of Pennsylvania Fall 2015
Workplace wellness programs have become a popular and developing area of research over the past 30 years. The rising focus on health, work/life balance, and overall employee wellbeing is becoming an attractive component for job-seekers in today s market. It is additionally being viewed as an advantageous module for corporate organizations to supply. Comprehensive worksite programs typically encourage health promotion and disease management that integrates specific components that are reflective of corporate objectives (Pelletier, 2011). Most business programs focus on exercise, nutrition, and results from health screenings (Walsh, 2015). Nonetheless, some programs may place additional emphasis on financial, social, or mental health. The possibilities are practically endless when it comes to selecting the core guidelines to build the foundation of a corporate health promotion program. For this reason, there have been poorly applied plans resulting in unsuccessful results and a negative stigma on the subject. The purpose of this paper is to assemble information on how worksite wellness programs can benefit both employer and employee when appropriately implemented and maintained. Best Practices When it comes to worksite wellness programs, there is no such thing as one size fits all (Goetzel et al., 2014). Some companies may commit an entire department to wellness with a staff solely focused on the execution of a successful program. Other companies may incorporate a lax approach with random utilization of health risk assessments or a health improvement website. Companies that may operate under the latter model tend to be ineffective and are characterized by random acts of wellness (Goetzel et al., 2014). Research indicates that specific practices have repeatedly been shown to lay the groundwork for successful programming. While these characteristics are not definitive, they are more likely than not to insure a successful intervention (Pelletier, 2009). The National Institute for Occupational Safety and Health (NIOSH) formulated a list in 2008 dividing essential components into four broader areas: organizational culture and leadership, program design, program implementation and resources, and program evaluation. These headers will be used to further discuss best practices established by NIOSH and supporting research.
Organizational Culture and Leadership The most repeated theme when it comes to effective corporate health promotion programs is culture. It appears to be the most valuable component across the board, being able to significantly make or break a wellness agenda. Successful comprehensive health promotion plans are typically founded on a culture that support individuals efforts at changing lifelong health habits by putting in place policies, programs, benefits, management, and environmental practices that intentionally motivate and sustain health improvement (Goetzel et al., 2014, p. 930). NIOSH describes this quality as a Human Centered Culture, thriving on worker participation, input, involvement, and trust (2008). Examples of environments that cultivate wellbeing could provide healthy food options in the cafeteria, vending machines, and staff meetings, promote smoke-free grounds, encourage taking the stairs as the norm, and generate a daily philosophy that making a healthier option becomes the automatic choice woven into the fabric of the organization (Goetzel et al., 2014). Involvement from those in leadership positions is also correlated with program success. It has been said the executives that devote their own time to the programs genuinely care about the health of their workers and their families. By participating themselves, they are leading by example instead of preaching about behaviors to their workforce (Goetzel et al., 2014). NIOSH describes the connection between workforce wellbeing and core services and values should be widely communicated and acknowledged by leaders (2008). Organizational commitment and executive management support are mentioned as best practices in other studies, further enforcing the importance of team investment at all levels (Pelletier, 2011). Some additional best practices that have been presented and fall under the culture and leadership category are linking the program to business objectives, as well as effective communication between departments such as wellness, human resources and employee assistance (Goetzel et al., 2014; Pelletier, 2009). Program Design Another frequently mentioned best practice is offering incentives or rewards to participants. Financial gains, time off, and recognition may encourage and motivate employee engagement in a worksite wellness program. These incentives should be aligned with the
accomplishment of the challenge at hand (NIOSH, 2008). Additional research lists incentives for employees to participate and incentives to motivate employees to participate in the program, leading to high participation rates as best practices to implement (Pelletier, 2009). The Centers for Disease Control and Prevention (CDC) also points out to employ features and incentives consistent with an organization s core mission, goals, operations, and administrative structures (Goetzel et al, 2014, p.930). For example, the participant who walks the most miles during the open timeframe of a contest can win an electronic fitness tracker. While some people may be willing to participate for the sake of increased wellbeing, others may be more inclined to partake if there is an immediate reward at stake. Another point from the NIOSH list of top methods is to integrate relevant systems. In the attempt to offer a comprehensive program, it would be beneficial to present sessions on behavioral, mental, physical, social, and financial wellbeing. The message and goal of overall wellness would be contradicted by only focusing on a single point of health (NIOSH, 2008). This same point is also listed as a wide variety of program offerings in another collection of beneficial characteristics (Pelletier, 2011). Employee participation and input should also be valued when implementing and maintaining a corporate wellness model. Active participation is usually the most effective strategy for changing culture, behavior and systems (NIOSH, 2008). It is beneficial to all parties to appreciate feedback and suggestions from those who are on the receiving end of services. Worksite wellness programs should never be perfect; instead always evolving and growing based on experiences from participants and the organization. Employee input when developing goals and objectives is similarly listed as characteristic of a sustainable program (Pelletier, 2009). Program Implementation and Resources; Program Evaluation Implementation and evaluation are both important factors that cannot be ignored when establishing a company-wide health promotion series. Effective communication, accountability, accessibility to resources, and employee education should all be valued components of wellness program management (NIOSH, 2008; Pelletier, 2009). Health promotion plans should also be
regularly evaluated using well-defined measures of success (Goetzel et al., 2014). NIOSH additionally mentions this step as a valuable phase to learn from experience and analyze progress (2008). Ongoing program evaluation is a necessary aspect in the maintenance of a successful program, as evidenced in multiple best practices lists (Pelletier, 2011). Benefits for Employees The worksite can be a very influential setting for guided improvement in healthy behaviors and to promote health education. Direct access to a large audience where there is already open communication is a prime platform to utilize for wellness programming (Neville, Merrill, & Kumpfer, 2011; Merrill & Hull, 2013). The primary goal of health promotion programs is disease prevention for participants (Goetzel et al., 2014). A critical element of comprehensive worksite wellness programs is to offer individualized, risk reduction support for all, especially those who present as high-risk (Pelletier, 2009). Analysis of research implies promising future directions appear to be with disease management programs that combine comprehensive plus high-risk interventions that focus on a dose-response model of increasing levels of intensity (Pelletier, 2011, p. 1329). It has been reported that 90% of US companies with 200+ employees offer a wellness program to their staff (Walsh, 2015). Well-designed and well-maintained programs have been shown to present positive results for the members, especially as they continue along a health plan (Musich, McCalister, Wang, & Hawkins, 2015). Improved Health Changes in health are typically measured by assessing a starting point and retesting the same components over a given period of time (Goetzel et al., 2014). The general topics of focus are health habits (diet, exercise, alcohol intake, cigarette smoking, seat belt use, sleep patterns); biometric characteristics (cholesterol, blood pressure, BMI, blood glucose); and well-being (stress, depression, overall health) (Goetzel et al., 2014). There has been evidence of individuals improving health risk scores by 23% in 24 months when compared to non-participants, as well as testifying to a perceived improvement in quality of life (Goetzel et al., 2014). There have been many studies performed with the focus on worksite wellness programming, a number that
continues to rise as the concept becomes more popular. One study reports decreases in BMI, waist circumference with increases in physical activity, work productivity, and health care use by participants over a two-year period (Pelletier, 2009). Another study detailed improvements that occurred between first and second screenings specific to blood pressure, total cholesterol, HDL, and glucose. Additionally, there were increases observed in exercise frequency, pleasure in participation and mental health (Pelletier, 2011). Butler et al., (2015) performed a research study examining a worksite walking program which resulted in 73% of participants recognizing a beneficial change in themselves, 9% contacting their physicians for health exams, and 4% changing or beginning a medication during the study. Overall greater levels of physical activity and improved cardiorespiratory fitness within 8 weeks were reported (Butler et al., 2015). Yet another study accounts that 9 of the examined 12 health risks showed significant improvement over time, primarily physical activity and nutrition, along with impressive declines in smoking habits (Musich, McCalister, Wang, & Hawkins, 2015). Analysis reports have also indicated positive changes in cancer risk reduction, better nutrition, improved fitness levels, decreased substance abuse, improved happiness, and improved aerobic score (Merrill & Hull, 2013). Long-term participation in a worksite wellness program appears to better BMI measures, blood pressure, and cholesterol, as well as nutrition and physical activity habits. Furthermore, those with higher recorded levels of physical activity have showed the least amount of weight gain over the course of a study (Neville, Merrill, & Kumpfer, 2011). This suggests that increases in physical exercise are inversely correlated with weight gain and increased body fat. Individuals are also improving their health by decreasing their chance for chronic diseases such as diabetes (Neville, Merrill, & Kumpfer, 2011). It is clear that there are widely reported instances of positive and beneficial health outcomes for those who partake in a worksite wellness program. Incentives As mentioned above, incentives for participation are described as a best practice for success. While many companies are offering health promotion programs at work, participation rates have been recorded to linger around 20% as employees may be leery to allow their company to track their personal health habits. As a result, 61% of large companies have turned
to financial compensations for those employees who take part in a workplace wellness initiative (Walsh, 2015). Merrill & Hull also speak to the motivation of participants by offering financial incentives for members (2013). One wellness program reported participants could earn $25 toward a year-end premium refund for each challenge they successfully completed, which increased to $50 per activity in 2008. Over the course of their study, there was opportunity to take part in 16 activities, equaling a minimum of $400 in rewards (Merrill & Hull, 2013). Reportedly, a top reason for enrolling in a worksite walking program for 74% of survey respondents was to receive a free health assessment (Butler et al., 2015). Some individuals require additional motivation besides the expected health improvements, which is why the added financial rewards have been shown as an effective incentive. Benefits for Employers Just as important for the success of a wellness program is the benefit to the organization. Success is harder to determine in corporate terms as hard numbers are tougher to come by than the statistical health reports for employees. Review of several studies shows evidence of large employers implementing worksite health promotion programs and seeing substantial positive returns, even during the initial years of inception (Baicker, Cutler, & Song, 2010). Return on Investment (ROI) Pelletier s analyses of several studies over many years have recently shown 15 of 43 studies focusing on and reporting positive ROI (2009; 2011). When it comes to the figures, numerous studies have calculated actual dollar amounts on savings. While these numbers do fluctuate in range, it is important for businesses to realize that there can be an actual financial return on investment once implementing a well-organized health promotion program. Some of the reported results are savings of $1.08 in medical expenditure for every dollar spent on the program, savings of $1.65 to $4.72 for every dollar invested in worksite wellness program within 2-4 years of inception, and savings of $3.27 on medical costs and $2.73 on absenteeism for every dollar spent on wellness programs (Pelletier, 2009; Musich, McCalister, Wang, & Hawkins,
2015; Baicker, Cutler, & Song, 2010). The Well at Dell program reports that it has achieved a $226.63 medical and disability savings for the $91.46 dollars spent per participant (Musich, McCalister, Wang, & Hawkins, 2015). Interestingly, it has also been researched that combined off-site costs of health care dollars and dollars of lost productivity are nearly twice as high as onsite dollars for operational costs (Pelletier, 2009). Increases in low-cost health care spending as individuals improve self-care has also been reported; therefore, these preventative measures have reduced high-cost claims that may have occurred later (Pelletier, 2009). Overall, health risks are consistently documented to correlate with increased health care costs and research suggests involvement in a well-designed wellness program may improve the participant s health (Musich, McCalister, Wang, & Hawkins, 2015). On the other hand, worksite health promotion programs have been referred to as one of the biggest scams ever initiated by the American health care industry (Goetzel et al., 2014). There are heavy costs that are usually incurred throughout the maintenance of a program, but especially in the startup phase: fees to vendors, salaries of staff to manage the program, compensation to employees to participate in programming during work hours, and rewards/incentives for participants (Goetzel et al., 2014). It is likely there are several failed programs that have gone unreported as companies would not like to publicize their shortcomings (Goetzel et al., 2014). Lowered Presenteeism & Absenteeism It is a common understanding that poor employee health is associated with productivity loss (Chen et al., 2015). Absenteeism refers to the loss of work time due to health reasons and presenteeism is described as self-reported impaired work performance due to illness (Chen et al., 2015). As presenteeism for men and women, and absenteeism for women increased, there was corresponding evidence of high biometric lab values, elevated cigarette and alcohol intake, and poor emotional health, chronicling a significant and consistent relationship among these behaviors (Pelletier, 2011). Additional studies state that participation in a wellness program over time was inversely correlated with absenteeism, fewer sick days were taken among wellness program participants than those who did not participate, and healthier employees are more productive and miss fewer days of work than their unhealthy counterparts (Pelletier, 2011;
Merrill & Hull, 2013; Baicker, Cutler, & Song, 2010). Relatively common conditions have been estimated to result in the following loss in productivity per employee per year: hypertension, $392; heart disease, $368; and depression, $348 (Chen et al., 2015). Presenteeism has been shown to decrease as workplace support increased in regards to healthy living and physical activity (Chen et al., 2015). Low Turnover As mentioned above, a positive and encouraging office culture can serve for many positive outcomes. Rallying together to encourage healthy lifestyles can promote a constructive sense of community (Merrill & Hull, 2013). A more engaged and motivated workforce has been known to increase attraction and employee retention for an organization (Goetzel et al., 2014). While reduced health care costs and reduced absenteeism are primary focal points in employer benefits, reduced turnover is also a likely result for a well-managed worksite wellness program (Baicker, Cutler, & Song, 2010). Working in such an uplifting and supportive atmosphere can steer employees to follow the example and adopt the wellness philosophy. Summary Worksite wellness programs have received heightened attention over the recent years. There has been much speculation on the effectiveness and purpose of a health promotion program in the workplace. While there have been disputing reports over time on the validity of programming, the discussion has recently shifted. The dialogue has gone from if a program should be implemented to how they should be designed and maintained to achieve optimal outcomes. As there is not a one size fits all model to implement, there are several researched and suggested best practices that organizations can apply to their wellness programming. First and foremost, a culture of healthy choices and wholesome habits should be fostered. By creating an overall supportive environment, employees will be more likely to buy-in to the philosophy. Additionally, the executive level staff should participate to further enthusiasm for the program. It is unlikely to generate buzz when the people at top are simply preaching the methods but not practicing them. The more engrained healthy choices and options are in the work environment,
the more likely employees are to partake. There should also be a line of open communication, welcomed suggestions, and adjustments made from constructive feedback. Employees can be more inclined to participate if they have a say in the formatting. Additionally, programs should self-evaluate frequently throughout the program for ways to improve. It is important to keep events and modules relevant to the targeted population and changing technologies. There have been a plethora of studies reporting on the beneficial outcomes for employees to participate in a well-administered wellness program. The primary goal of most programs is to guide employees away from disease and illness. There are reports of health improvements that have included decreased risk of cancer, lower BMI, improved cardiovascular output, decreased risk for chronic disease, improved mental health, declines in smoking habits and alcohol intake, increased use of seat belts, and an improved overall quality of life. It is rare to find a study that reports declines in health after participation. An additional benefit of involvement could be receipt of financial rewards. Many programs include prize incentives to additionally motivate their employees to participate. Decreases in health insurance premiums, cash, and other prizes are potential bonuses that participants can work towards. It is also beneficial for employees to work in a positive and encouraging environment, which is a primary emphasis for well-managed programs. Focus on a productive work/life balance, encouragement to improve overall wellbeing, and general investment in employees can breed confidence, appreciation, and happiness within an organization. There are also promising benefits for the corporations who offer worksite wellness programming. A primary point of examination is return on investment (ROI). Many researchers have investigated the costs that go into implementing and maintaining a program as well as the financial return that is hopefully realized. It is likely that a program that follows suggested best practices will ultimately see financial gains after the initial execution of the health promotion program. Additionally, there have been reports on improved levels of absenteeism (productivity loss based on health) and presenteeism (productivity loss based on impaired work due to illness) for those who engage in wellness sessions. Fewer sick days tend to be taken by those in the healthy lifestyle programs and healthier employees are typically more productive than their unhealthy counterparts. Furthermore, employees who are happy, feel encouraged, and appreciate their environment are less likely to leave their position. They are also more likely to produce quality work and invest themselves in their company. When all moving pieces sync into place,
with the combined efforts of all parties, a worksite wellness program can result in a significant win-win.
References Baicker, K., Cutler, D., & Song, Z. (2010). Workplace wellness programs can generate savings. Health Affairs, 29(2), 304-311. doi: 10.1377/hlthaff.2009.0626 Butler, C. E., Clark, B. R., Burlis, T. L., Castillo, J. C., & Racette, S. B. (2015). Physical activity for campus employees: A university worksite wellness program. Journal of Physical Activity and Health, 12(4), 470-476. Chen, L., Hannon, P. A., Laing, S. S., Kohn, M. J., Clark, K., Pritchard, S., & Harris, J. R., (2015). Perceived workplace health support is associated with employee productivity. American Journal of Health Promotion, 29(3), 139-146. Goetzel, R. Z., Henke, R. M., Tabrizi, M., Pelletier, K. R., Loeppke, R., Ballard, D. W.,... & Metz, R. D. (2014). Do workplace health promotion (wellness) programs work? Journal of Occupational and Environmental Medicine, 56(9), 927-934. Merrill, R. M., & Hull, J. D., (2013). Factors associated with participation in and benefits of a worksite wellness program. Population Health Management, 16(4), 221-226. doi: 10.1089/pop.2012.0064 Musich, S., McCalister, T., Wang, S., & Hawkins, K. (2015). An evaluation of the Well at Dell health management program: Health risk change and financial return on investment. American Journal of Health Promotion, 29(3), 147-157. National Institute for Occupational Safety and Health. (2008). Essentials elements of effective workplace programs and policies for improving worker health and wellbeing (DHHS (NIOSH) Publication No. 2010-140). Washington, DC: Government Printing Office. Neville, B. H., Merrill, R. M., & Kumpfer, K. L., (2011). Longitudinal outcomes of a
comprehensive, incentivized worksite wellness program. Evaluation & the Health Professions, 34(1), 103-123. doi: 10.1177/0163278710379222 Pelletier, K. (2009). A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: Update VII 2004-2008. Journal of Occupational and Environmental Medicine, 51(7), 822-837. doi:10.1097/jom.0b013e3181a7de5a Pelletier, K. (2011). A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite. Journal of Occupational and Environmental Medicine, 53(11), 1310-1331. doi: 10.1097/JOM.ob013e3182337748 Walsh, B. (2015). America s evolution towards wellness. Journal of the American Society on Aging, 39(1), 23-29.