Wellness Program Blog

Employee Engagement is the level at which workers are aligned with and working toward company objectives. Employee Engagement is altered by a wide range of factors that comprise of internal talks, company structure, benefits and recognition.

Companies that have high levels of employee program engagement benefit from improved productivity, retention and achievement than peers with disengaged workers.  Levels of engagement among workers in the U.S. have been declining over the past several years as individuals have become disillusioned with the treatment of workers by employers. The inability to involve workers is one of the reasons why, despite steady rises in hours worked, America lags behind several other nations in terms of employee productivity per hours worked.

Company Wellness Programs may increase employee program engagement in several ways. First, when communicated properly, they show to workers that the company cares about their wellness. This can improve retention and turnover as well as supply a greater discretionary effort from workers. During a period of significant downsizing, Motorola found more of an interest in its Company Wellness Programs as managers recognized the value of providing for the health and wellness of workers.

In addition, the health improvements will lower absenteeism and presenteeism (when workers continue to work despite decreased productivity), allowing for more time spent at full productivity. Lastly, healthier workers are more likely to have increased morale, which translates into a more enjoyable and more effective work environment.

Over the past several years health care insurance premiums have risen at a steady pace. This is taking a toll on the bottom-line of employers, cutting into profits, limiting growth and forcing a reevaluation of a once sacred employee benefit system. According to a projection by McKinsey & Co., at the present rate, by 2008 health benefits will eclipse profits at the average Fortune 500 company.

Companies, through private health care insurance employers, are the leading provider of medical services in the U.S.. In 2004, 59.8 percent of American citizens were covered by a company-based health care insurance program, accounting for 88 percent of all private health care insurance. Yet the increasing costs of Health Care, ever-increasing drug prices and a steady rise in chronic illnesses have brought the corporate world to a breaking point.

For many employers the increasing burden has become too difficult to carry. Over the past five years health care insurance premiums have raised an average of 11.6 percent each year, more than four times the average rate of inflation and employee earnings over that time.3 Not surprisingly, this exponential growth in premiums has caused the number of employers offering Health Care services during that time to drop from 69 percent to 60 percent.4 In addition, in 2005,  health care insurance premiums jumped 9.2 percent, more than three times the rate of inflation – and that was the lowest increase in the past five years.

In this environment employers need to discover innovative ways to mitigate the rising costs of Health Care coverage. Seemingly, the easiest strategies to accomplish this goal would be to reduce benefits coverage or pass on agrowing burden to workers and retirees. Greater than 80 percent of employers have chosen one or both of these cost saving measures in the past several years and almost half of all big employers are likely to increase the amount workers pay in 2007.5

However, these approaches do nothing to address the fundamental causes of rising premiums, one of which is a population that requires increased healthcare. To make a lasting and meaningful effect on premiums and central health, employers need to look beyond a traditional reactive-based approach.

It is recommended that smoking cessation programs subscribe to the Code Of Practice for Smoking Cessation Programs.

Smoking cessation programs ought to be multi-component with a focus on skills to build positive voluntary behavior modification practices. Useful techniques include starting reasons for quitting, understanding the smoking habit, various techniques for stopping and remaining a non-smoker, overcoming the problems of quitting, short-term objective setting, weight management, stress management, effect of exercise, relationship of alcohol consumption to urges to use tobacco. Use no aversive or scare tactics.

In programs that use aids such as the “patch” or medications such as “Zyban” appropriate consultation ought to be available on the usage of these aids.

The instructor ought to have formal training in smoking cessation from a nationally recognized company such as American Heart Association, American Cancer Society, American Lung Association, or a nationally recognized commercial program such as Smoke Enders.

Evaluation of success is sometimes very dubious in smoking cessation programs. Measurement of success ought to include participation rate, including the number implementing the program, the number completing the program, and the average number per session. Also included, number and percent who stopped smoking at the end of the program, and the number and percent who had not resumed smoking by the end of one year.

Program provided is consistent with scientific and medical care recommendations for weight loss, reflects a multi-disciplinary approach which offers four components: behavioral, exercise, nutrition, and maintenance, and is in accordance with the document Guidance For Treatment Of Adult Obesity. It includes:

• Screening to verify that the colleague has no medical or psychological conditions which would make weight loss inappropriate, and to identify the colleague’s level of health risk, classifying participants not only on excess body weight, but also on the basis of associated medical conditions and central heath risk.
• Referral for participants who are morbidly obese who would require medical care guidance for weight loss.
• Informed consent, explanation of potential physical and psychological risk from weight loss and regain, likely long-term success of program, full cost of the program, credentials of the employee.
• Identification of contributing factors to colleague’s weight status, serving as the basis for an individualized weight loss plan which includes the weight objective and plans for nutrition, exercise, and behavioral components.
• Weight objective of colleague is reasonable based on personal and family weight history not solely on height and weight charts; initial weight loss objective does not exceed loss of 10% of body weight, 1-2 pounds per week.
• Explanation of unsafe weight loss methods.
• Daily calorie level is adjusted to meet each colleague’s recommended rate of weight loss.
• Daily caloric intake is not less than 1,000 calories; if less, physician monitoring is required.
• Food plan designed so participants can find foods which meet 100% of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation can be used to achieve RDAs, however ought to not greatly exceed RDAs.
• Nutrition education encouraging permanent healthful eating habits based on The Food Guide Pyramid.
• Participant involved in meal planning and food selection.

The protein, fat, carbohydrate, and fluid content of the food plan meet safety recommendations:

Protein    Between 0.8 and 1.5 grams of protein per kilogram of objective body weight, but no more than 100 grams of protein a day.
Fat    10 – 30% calories as fat.
Carbohydrate    At least 100 grams per day.
Fluid    At least one liter of water daily.

• Exercise component ought to be a valuable portion of the program and be both didactic and experiential.
• Participant is appropriately screened for exercise using a evaluation questionnaire such as the Par-Q Readiness Assessment (see forms). Instruction on recognizing untoward responses to exercise.
• Members work towards 30-60 minutes of exercise 5-7 days per week.
• No appetite suppressant drugs.
• Maintenance plan provided for continued support.
• Weight control programs ought to be conducted by a registered dietitian or by degreed health professionals with training in nutrition with consultation by a registered dietitian.
• Trained lay leaders may support  if supervised by nutrition professional.

Note: There’s an interactive version of Guidance for the Treatment of Adult Obesity at e-Guidance for the Treatment of Adult Obesity.

A program is required to offer appropriate interpretation of blood lipid evaluation results, including a caution that a single measurement neither excludes nor establishes a diagnosis of their blood cholesterol.

Follow national standard procedures:

Total Cholesterol
Desirable cholesterol    < 200 mg/dl
Borderline cholesterol    200 – 239 mg/dl
High cholesterol    > 240 mg/dl

HDL
Desirable HDL     > 35 mg/dl
Low HDL     < 35 mg/dl

Refer blood lipid evaluation participants to medical care as follows:

Total Cholesterol
< 200 mg/dl     Recheck blood lipid in five years, if history of coronary heart disease or if two or more CHD risk factors are detected refers to risk reduction program or health professionals, as appropriate.
200 – 239 mg/dl     If history of CHD or if two or more other risk factors are detected, refer to medical care or risk reduction service within two months; if no stated history of CVD or less than two other risk factors, reassess blood lipid status within 1-2 years.
> 240mg/dl     Refer to medical care within two months.

HDL
> 35 mg/dl    If fewer than 2 risk factors and borderline total cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Provide the following:
• The relationship of blood lipids, elevated Blood Pressure (BP), and other risk factors.
o Risk factors include: elevated Blood Pressure (BP) 140/90 or higher or on hypertension medication; current tobacco use; family history of premature CHD; diabetes mellitus; age – male > 45 years, female > 55 years or premature menopause without estrogen replacement therapy.
o Negative risk factor: high HDL 60 mg/dl or greater (subtract one risk factor).
o Risk factors such as family history, smoking, high fat or other unhealthy diet, and lack of exercise lead to the development of cardiovascular disease (CVD).
• Definitions and causes of elevated blood lipids and HDL, desirable levels, the meaning and limitations of a single measurement, the cause of variability, and the need for multiple measurements prior to diagnosis.
• Wide range of treatment options, including diet (e.g., effect of controlling fat intake less than 30% of total calories from fat, less 10% saturated fats), less than 300 mg. of cholesterol per day, well-balanced diet, weight maintenance or reduction, exercise, and medication.
• Importance of following prescribed treatment and professional advice.

Appropriate medical care or allied health professional trained in measurement of Blood Pressure (BP), referral protocols, and delivering educational messages to colleague conducting Blood Pressure (BP) programs. These programs are required to follow national standard procedures.

• National standard procedures for Blood Pressure (BP) protocols:
o Calibration of Blood Pressure (BP) calculating equipment
be done at least each year.
o Two or more measurements of colleague’s Blood Pressure (BP) ought to be taken.
o Referral of participants with elevated Blood Pressure (BP) readings to personal physician for further assessment.

• Systolic/Diastolic Follow-Up:
o Normal:   <130 / <85
Action: Recheck in 2 years
o High Normal:   130-139 / 85-90
Action: Recheck in 1 year

• Hypertension:
o Stage 1 (Mild):   140-159 / 90-99
Action: Confirm within 2 Months.
o Stage 2 (Moderate):   160-179 / 100-109
Action: Refer to source of care within 1 month.
o Stage 3 (Severe):   180-209 / 110-119
Action: Refer to source of care within 1 week.
o Stage 4 (Very Severe):   >210 / >120
Action: Refer to source of care immediately.

• Appropriate educational messages:
o Normal:   <130 systolic and <85 diastolic
Action: No referral. If on treatment, then inform colleague that Blood Pressure (BP) is under great control today and ought to continue seeing and following treatment program.
o High Normal:   130-139 systolic and/or 85-89 diastolic
Action: Recommend that colleague have Blood Pressure (BP) rechecked within 1 year unless under treatment. Advise colleague that the readings are in a high normal range that needs rechecking. In the interim, suggest that one of the most effective means to decrease Blood Pressure (BP) is to bring weight into normal range and to exercise.
o High:   >140 systolic and/or >90 diastolic
Action: Refer to physician for further assessment within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. If already on treatment, advise colleague of readings and need to get Blood Pressure (BP) to a objective of 140/90 or less.
o Isolated Systolic Hypertension:   140-159 systolic and < 90 diastolic in a colleague 65 years of age or older.
Action: Advise colleague to inform physician of readings at next visit and consider advice regarding weight loss and exercise if appropriate.
o Urgent:   180-209 systolic and/or 110-119 diastolic
Action: Recommend obtaining medical care assessment within 1 week.
o Emergency:   >210 systolic and/or >120 diastolic
Action: Obtain immediate medical care attention.

• Provides the following:
o Written results, referral standard procedures, and an explanation of Blood Pressure (BP) levels given to each colleague with individualized counseling, including advice about the interval of time recommended when the colleague ought to be checked again.
o Utilizes the recommendations in The Fifth Report Of The Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (BP), March 1994.
o Written and audiovisual materials that are informative, easy to be aware of, and useful while containing scientifically accurate information.
o Relationship of elevated Blood Pressure (BP) and other risk factors, such as family history, smoking, high fat and unhealthy diet, lack of exercise, in the development of cardiovascular disease, including stroke, kidney disease, heart attack, and other diseases.
o Definition and causes of elevated Blood Pressure (BP).
o Importance of following prescribed treatment.

A Health Risk Appraisal (HRA) is sometimes used in conjunction with a health evaluation. An HRA is a computerized assessment tool which looks at an individual’s family history, health status, and lifestyle. An HRA seeks to identify precursors associated with premature death or serious illness and quantifies the probable impact for each individual.

An HRA instrument is derived from an understanding of the course of a disease. Based on this understanding, useful prediction instruments can be constructed to assess the health risks of an individual. Individuals with a higher number of health risks tend to have more weighty health problems over time.

Drawing attention to their health risks can help clients decrease risk factors which lead to the onset of unnecessary disease and subsequent premature death. The questionnaire covers lifestyle habits (such as smoking, Safety Belt use, and exercise) and physical measures (such as blood lipids, Blood Pressure (BP) levels, height, and weight).

For accuracy, it is crucial to get direct measures of Blood Pressure (BP), blood lipids and HDL-cholesterol. The HRA also supports recommendations and indicates what risks are potentially modifiable. Types of measures to assess health risks are discussed under Screening Programs.

The impact of a health risk appraisal is much greater when it is given in-person, with immediate feedback to the client. This also supports an opportunity to invite the client’s participation in continuing health counseling and to gain their written consent to do pro-active outreach to them.

A health age can be computed based on the individual answers to the questionnaire and physiologic factors. The health age may indicate the individual to be younger or older than their chronological age.

HRA programs are one the most prolific types of wellness activities utilized by employers. Continuing research on HRAs is examining the efficacy of this tool. One of the big advantages of this tool is that it can offer an aggregate group report of a company and can be utilized as an assessment tool.

Detailed information is available from the Society of Prospective Medicine (www.spm.org/desc.html) who publishes a handbook on HRAs.

These are short informational “Health Tips” in an e-mail format on many different health-related topics. You can appoint someone within your company to find specific topics on the Internet from sites that are in the public domain or topics can be purchased from employers. Some qualified sources include:
• Hope Health
• Sound Ideas, Inc.
• Centers for Disease Control and Prevention
• National Institutes of Health

These e-mails can be sent daily, weekly or monthly. Our experience indicates weekly is the best frequency.

If the majority of your workers do not have e-mail, consider offering the information to them through:
• Bulletin boards
• Check stuffers
• Mailbox stuffers
• Newsletters

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SAMPLE #1 Worksite Wellness E-mail Messages

From: Company Wellness
To: Wellness Team
Subject: Layering for Exercise

One way to help ensure enjoyment of a winter walk (or run) is to make sure you’re dressed properly for the weather. And the secret to that, for a winter workout, is to dress in layers.
Layer 1 — Avoid 100% cotton in the first layer, next to your skin. Cotton holds moisture. Wear underwear made from manmade fabrics to wick perspiration away from skin.
Layer 2 — A zippered sweatshirt and sweatpants will keep you warm. Just open the zipper if you get too warm.
Layer 3 — If required, over the sweatsuit, you can add a waterproof and windproof jacket. If it’s very cold, you may want to wear a jacket made with goose down.
Hands — Mittens will keep your hands warmer than gloves.
Feet — Wear socks made from wool or manmade fabrics that keep your feet dry and warm. Avoid 100% cotton socks. Don’t wear sneakers or boots that fit too tightly … this will restrict blood flow and your feet will end up feeling colder.
Head — About 40% of your body’s heat is lost through the head. Wear a hat and cover your ears.
Lips — Don’t forget lip balm containing sunscreen … even in winter!

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SAMPLE #2 Worksite Wellness E-mail Messages

From: Company Wellness
To: Wellness Team
Subject: Energy Boosts

Need an energy boost? Here are some ideas for tapping into your own energy sources — and most require little effort.
• Get an extra hour of sleep. No surprise here — it is able to make a noteworthy difference in your energy level the next day.
• Eat less more often. Have small, balanced meals or snacks throughout your day for a steady supply of fuel and energy. Make note of which foods seem to boost your energy level.
• Drink sufficient amounts of water. Dehydration leads to to fatigue, which you can offset by drinking water throughout the day.
• Avoid alcohol and caffeine. Both can contribute to dehydration and fatigue. They also seem to disrupt sleep patterns.

Health Testing:

• Blood pressure

• Breast cancer Testing

• Skin cancer Testing

• Diabetes Testing

• Cholesterol Testing

• Eye exams

• Body-fat Testing

• Flu shots

• Posture screening, spinal analysis

• On-site child immunizations

• Prostate cancer screenings

• Fitness Testing

• Depression Testing

 

Physical Fitness Activities:

• On-site fitness center or exercise room

• Walking and/or running club (during lunch hour or breaks)

• Bike rack on premises (so employees can ride to work or during lunch)

• Mind/body classes (yoga, tai chi) initiatives

• Team sports (volleyball, basketball, softball)

• Host an exercise equipment swap

 

Lifestyle Change or Behavior Change Initiatives:

• Smoking cessation

• Weight management initiatives

• Substance abuse initiatives

• Physical Fitness activity

• Stress management initiatives

 

Safety and Prevention Initiatives:

• Back-injury prevention and training

• Ergonomic education

• Hand-tool safety initiatives

• Fire safety initiatives

 

Health Education, Awareness, and Support Initiatives:

• Lunch-and-learn or brown-bag wellness seminars (see your EAP for a list)

• Nutrition and diet information, plus provide healthy food alternatives in your vending machines and cafeteria, and provide food storage and preparation facilities to encourage healthier eating

• Prenatal care initiatives

• Work / Life Balance initiatives

• Elder care initiatives

• Cancer survivor support groups

• Financial education

 

Stress-Reliever Initiatives:

• Laughter bulletin board where employees can post jokes and cartoons (in good taste)

• Visiting massage therapist

• Stretch breaks

• Group lunches or celebrations

 

Disease Management Initiatives:

• Back pain

• Asthma

• Diabetes

• Depression

• Cancer

• Obesity

• Hypertension

Employee Health Services

• access to an EAP

• worksite medical services

• workplace medical examinations

• health risk testing and counselling:

            • blood pressure,

            • blood cholesterol ,

            • blood glucose clinics,

            • thyroid.

            • bone density testing,

            • prostrate

• promote self-exams – breasts, testicles

• medical surveillance Initiatives

• immunizations and flu vaccinations

• disability case management

• active rehabilitation

• return to work Initiatives

• self-care education (see health living Initiatives)

• disease management information and presentations:

            • diabetes,

            • stomach disorder,

            • arthritis,

            • asthma,

            • allergy,

            • pain control,

            • foot and back care Initiatives,

            • chronic tiredness,

            • migraines

• health on-line with continuous learning/reminders/tips

• daily/weekly/monthly email tips or news bulletins

• excercise appraisals

• health and safety fairs

• hand-washing tips and reminders

• visiting your doctor guide – tips to efficiency

• links and information on help lines