A Call to Action:
Creating a Culture of Health
2010 AHA Long Range Policy Committee Report
January 2011
A Call to Action: Creating a Culture of Health
• A bold call to action
for hospitals and their
employees to be
leaders in creating a
culture of health
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Background on hospital health
and wellness programs
Findings from a groundbreaking
AHA survey on hospital
employee health and wellness
activities
Examples of hospital best
practices
“How-to" recommendations for
the field
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Why Health and Wellness?
• Hospital and health system employees play critical role
in their communities to lead the way and serve as role
models for healthy living and fitness
• Financial case for creating a culture of health through
potential cost savings and improved employee
recruitment and retention
• Hospitals and health systems contributing to
achievement of national public health goals in Healthy
People 2020
• ACA incentives to promote employee health and
wellness
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Survey on Hospital Employee Health
and Wellness Activities
• National survey of hospital employee health and
wellness activities conducted May-June 2010
• 876 responses
• nationally representative of all hospitals in terms of
hospital size, teaching status, and census region
• urban hospitals and hospitals that were members of
a health system slightly overrepresented
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Survey on Hospital Employee Health
and Wellness Activities
• Most hospitals (86%) have an employee health and
wellness program, the vast majority of which (80%) are
directly administered by the hospital or health system.
• The top motivators for offering a program are to reduce
healthcare costs, improve the health of employees and
reduce absenteeism/presenteeism, improve employee
morale and productivity, and provide an example to the
community.
• The most common wellness programs offered include
flu shots, EAP/mental health services, smoking
cessation programs, and healthy food options.
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Survey on Hospital Employee Health
and Wellness Activities
• There is a wide variation in the percentage of hospital
employees participating in health and wellness
programs, with 42% of hospitals reporting that at least
half of their employees participate in one or more
programs.
• Hospitals promote their wellness programs through
health fairs (76%), health risk assessments (70%), and
incentives (66%). The overwhelming majority of
hospitals that offer incentives use positive incentives
such as health insurance premium discounts or gift
cards.
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Survey on Hospital Employee Health
and Wellness Activities
• Most hospitals (76%) require that employees participate
in at least one wellness program. Many hospitals also
offer incentives for employees who complete a wellness
program (50%) and achieve outcomes based on
participation (39%).
• HRA completion, participation in weight management or
smoking cessation program, and completion of a
biometric screening are activities commonly linked to
incentives. Hospitals with more than 200 beds are more
likely to utilize incentives.
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Survey on Hospital Employee Health
and Wellness Activities
• Slightly less than half (47%) of hospitals that use
incentives discount between 5% and 20% of an
employee’s monthly premium for participating in health
and wellness programs.
• A third of hospitals that use incentives award employees
who meet health and wellness incentives between $100
and $300 annually. An additional 41% of hospitals
award $100 or less.
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Survey on Hospital Employee Health
and Wellness Activities
• One-third of hospitals have made an attempt to measure
the return on investment (ROI) of employee health and
wellness programs, and only 7% have successfully
measured ROI. Of those who have successfully
measured ROI, the current median ROI of health and
wellness initiatives is between 2:1 and 3:1.
• Eighty-two percent (82%) of respondents who measure
ROI report that their ratio is equal to or exceeds
expectations.
• The most common measures used in evaluating ROI
are number of participants, number of completed HRAs,
overall direct health care costs, number exercising
regularly, and number achieving weight loss.
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Survey on Hospital Employee Health
and Wellness Activities
• Motivating employees over extended time periods,
financial restrictions or limitations, measuring program
effectiveness, and creating a culture of health are noted
as the most serious challenges to program
effectiveness. Urban hospitals and hospitals with more
than 200 beds find it more challenging to communicate
to their employees about health and wellness activities.
• Getting better ROI data is the most important
opportunity for improving health and wellness programs.
Additional opportunities include providing more
incentives to employees, providing new programs, and
providing different types of incentives.
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Our Recommendations
1. Serve as a role model of health for the
community.
2. Create a culture of healthy living.
3. Provide a variety of program offerings.
4. Provide positive and negative incentives.
5. Track participation and outcomes.
6. Measure for ROI.
7. Focus on sustainability.
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Recommendations
1. Serve as a role model of health
for the community.
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Use wellness programs as pilots to export to the
whole community as part of a population-based
approach to health care
Offer health and wellness program benefits to all
dependents of employees
Work with local employers to build an integrated,
regional approach to health and wellness
Provide free wellness programs at local community
centers.
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Recommendations
2. Create a culture of healthy living.
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Promote a holistic approach to wellness
Start commitment to culture change at the top—
with the CEO and the board of trustees
Consider creating a wellness department led by a
chief wellness officer who reports directly to the
CEO
Make changes to the work environment that
promote healthy behavior
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Recommendations
3. Provide a variety of program
offerings.
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Include a health risk assessment (HRA) and
biometric screening in all hospital wellness
programs
Implement at least one intensive coaching activity
Make smoking cessation mandatory for all
employees and subsidize and/or offer only healthy
food options in all hospital cafeterias and vending
machines
Re-evaluate wellness programs annually
and adjust as necessary
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Recommendations
4. Provide positive and negative
incentives.
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Expand use of incentives to improve participation
levels
Experiment with various types of incentives and
measure effect on participation and outcomes
Shift toward more outcomes-based incentives as
participation increases
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Recommendations
5. Track participation and
outcomes.
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Initially focus on measuring and increasing
participation levels, then move on to tracking
outcomes
Track participation levels in a number of ways,
e.g., number of overall participants, number
completing a HRA, number enrolled in smoking
cessation programs
Track outcomes in a number of ways, e.g., number
who achieved weight loss, number who
ceased smoking
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Recommendations
6. Measure for ROI.
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Ensure multi-year commitment to measurement,
evaluation and improvement
Start small by measuring ROI on subset of
wellness programs
Focus attention on finding effective metrics—”hard”
and “soft”—that work for your institution
For validity, match employees who have
undergone an intervention with employees with
similar characteristics who did not participate
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Recommendations
7. Focus on sustainability.
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Approach wellness as a constant activity, not just
an annual event
Dedicate resources to constantly communicate—
through multiple modes and media—with staff,
educate and incentivize participation
If necessary, start small, demonstrate success,
and build up to full range of wellness activities
Change programs and incentives as necessary to
maintain high levels of participation
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Health and Wellness Best Practices
Hospital/Health System Best Practice
Truman Medical Centers,
Kansas City, MO
“PTO for Wellness” program – allows employees to trade
paid time off (PTO) hours for reimbursements for wellnessrelated expenses
Ochsner Health System,
Jefferson, LA
Voluntary wellness program with significant insurance
premium discount
Sentara Healthcare,
Norfolk, VA
Mission: Health, an incentive-based wellness and disease
management program
St. Elizabeth Medical
Center, Wabasha, MN
Robust wellness program with numerous offerings that is
managed by a wellness committee
HCA, Inc., Nashville, TN
Calculates ROI of a diabetes pilot program in multiple
ways, with a focus on clinical outcomes and claimsreduction data
Henry Ford Health System,
Detroit, MI
Developing data collection methodology at beginning of
interventional, controlled trial for chronic back pain with
major employer provided data to expand program to other
employers and community organizations
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A Call to Action: Creating a Culture of Health
www.aha.org/wellness
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