Generating & Measuring Healthy
Workplace Outcomes
Health Work & Wellness Conference
September 30, 2010
Peter Melnyk PhD & Allan Smofsky
Agenda
- Literature review:
WHP in Canadian
worksites
- Emerging definition of
healthy workplace:
what it means to
different stakeholders
Employer survey:
- Components of
Canadian WHP
strategies
- Measuring healthy
workplace outcomes
- New/emerging
strategies
- WHP program
evaluation
where are we now?
- Focus on Canadian
employers
- Generating healthy
workplace outcomes:
some emerging
opportunities
where are we going?
Background
 evolution of WHP understanding:
“a marketing process
which produces
widespread and
sustained employee
participation in
healthful activities”1
employee health is
a combination of
personal and
worksite inputs
 more comprehensive WHP initiatives need a more scientific approach:
 clear objectives and well defined endpoints/outcomes
 robust evaluation of program outcomes
 clear positioning/integration of WHP within the corporate culture
1. Wilbur CS Prev Med 1983;12(5):672-81
Initial Objectives
Review the biomedical literature and other publicly available sources of
information on the topics of:
workplace health promotion (WHP) and disease management in Canada
to identify:
 best practices
 key clinical
 humanistic and
 economic outcomes measured in WHP evaluation
Methods
 most articles were retrieved from a structured PubMed search of peer-reviewed
literature:
key search
terms
PubMed
screening
abstracts
full text
screening
data
extraction
 approximately 35 studies meeting the search criteria were published and
indexed by PubMed over the last 5 years
 other sources investigated: Canadian Association for Population Therapeutics (CAPT)
meeting abstracts, Public Health Agency of Canada, Canadian Healthy Workplace
Council
General Results I
benefit costs1
other
disease categories
these
conditions are
preventable
or modifiable
through
behavioural
changes

70%
the Canadian WHP programs identified primarily targeted:


cardiovascular,
musculoskeletal,
respiratory,
digestive,
cancer,
stress.
cardiovascular health, general health, musculoskeletal disorders
disease management – absent from the peer reviewed literature..
1. Public Health Agency of Canada. Active living at work - Trends & impact: the basis for investment decisions. 2007.
http://www.phac-aspc.gc.ca/alw-vat/trends-tendances/index-eng.php
General Results II

Key factors that contribute to successful WHP initiatives are:
Targeting several
health issues
• Integration of
occupational health
and safety with
workplace wellness:
• enhanced
effectiveness
• employee receptivity
Attaining high
participation
`
Successful
WH
Strategy
Integrating WHP into the
organization’s culture and
operations
• time & access
.
`
on-site services
• incentives
Workplace Wellness Programs in Canada

Increasing focus among employers on employee health and well-being


much of the focus has been on education to modify personal health practices
studies report that—to be truly effective—a workplace wellness program must consider
appropriate organizational and policy changes
91%

2009 Buffet and

Company2
survey (N=634):
many initiatives not designed to
generate outcomes (e.g. flu shots)
100
90
80
70
60
offer some type
of wellness
initiative
44%
50
40
30
20
10
0
1997
2009
2. Buffet and Company. 2009 Wellness Survey.,3. Stewart N. The Conference Board of Canada, 2010
Workplace Wellness Programs in Canada

2010 Conference Board of Canada Survey (N=255):3
70
64% of survey
respondents agreed that
their benefit programs
focused on health
promotion and disease
management, but…
60
50
40
30
20
10
0
3. Stewart N. The Conference Board of Canada, 2010
only 26% of respondents
reported that their organization
has fully developed a
comprehensive wellness
strategy
Components of WHP programs
offered in Canada

The most commonly offered elements of WHP initiatives among Canadian
employers include:
• often offered as stand alone measures not

employee assistance programs: 94-97%
 CPR/first aid training: 84%
 flu shots/immunizations: 78-83%

strategically
incorporated as part of a comprehensive WHP
approach
• conclusive evidence on the impact of EAP on
performance is needed
The least commonly offered components:

on-site medical care: 19-21%
 24 hour nurse line: 22%
 fitness counselling: 17-22%

There is variability in the types of components offered in different regions of
Canada
Program evaluation I


Lack of robust data collection in the area of employee health:
The literature describes a number of reasons for this

many managers simply accept that healthier employees are more productive
 employee health not consistently managed or monitored by health professionals
 human resources professionals may not receive training necessary to interpret
and manage employee health and wellness

resources/tools available
Data on employee health/well-being is typically gathered using a macro
perspective which is difficult to reconcile with the more granular employee
engagement/productivity data
Program evaluation II

Program evaluation is a key component of long-term success; however
detailed measures of WHP program impact on health risks, employee
productivity and costs are often not collected

Tune Up Your Heart1 – designed with a focus on measurement and evaluation
of health outcomes






risk assessment; tailor intervention to risk strata
measurements of systolic and diastolic blood pressure, lipid levels & BMI
smoking and diabetes status were determined
pre/post analysis of statistically significant changes in components of risk
historical data: annual per capita costs for life insurance, absenteeism, STD, LTD
and prescription drugs
Outcomes:



components of risk
risk status
economic outcomes
1. Chung M, et al. Worksite health promotion: the value of the Tune Up Your Heart program. Popul Health Manag. 2009 Dec;12(6):297-304.
Evaluation metrics

Health & Well-being

Primary health and well-being outcome measures
used in studies identified in the literature search:






body mass index
 short term disability
blood pressure
cholesterol and triglyceride levels
self-reported stress level
smoking cessation rate
Other metrics?
Evaluation metrics

Economic

Primary economic/productivity outcome measures used in identified studies:





absenteeism
WCB costs
short-term disability claims
annual grievances
Evaluation of WHP success or failure not based on any single metric
Defining a Healthy Workplace –
current (Canada)
Healthy,
Productive,
Successful
Workplaces
Safe & Healthy Work
Environment
WHO Definition of Health

Health: A state of complete physical, mental and social well-being, and not merely
the absence of disease

Workplace Health (new): A healthy workplace is one in which workers and
managers collaborate to use a continual improvement process to protect and
promote the health, safety and well-being of all workers and the sustainability of the
workplace by considering the following, based on identified needs:




health and safety concerns in the physical work environment
health, safety and well-being concerns in the psychosocial work environment, including
organization of work and workplace culture
personal health resources in the workplace; and
ways of participating in the community to improve the health of workers, their families and
other members of the community.
Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010
Defining a Healthy Workplace- new
Safe & Healthy
Work Environment
Mobilize
Adapted from World Health
Organization, 2010
Supportive
Psychosocial
Work
Environment
Assemble
Improve
Leadership
Engagement
Evaluate
Healthy,
Productive,
Successful
Workplaces
Assess
Employee
Involvement
Do
Prioritize
Plan
Corporate Social
Responsibility
Personal
Health /
Lifestyle
Resources
Defining a Healthy Workplace
Safe & healthy work environment includes:


Physical work environment: structure, air, machinery, furniture, products, chemicals,
materials and production processes in the workplace¹
Process Elements






Ergonomics
Emergency response
Injury prevention
Disability case management
Environmental practices
Culture Elements






Assessing impact of work culture on health & safety performance
Supervision
Empowerment
Teamwork
Workload
Harassment/bullying prevention & management
¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010
http://www.who.int/occupational_health/publications/healthy_workplaces_model.pdf
Defining a Healthy Workplace
Personal Health / Lifestyle Resources include:

The health services, information, resources, opportunities, flexibility and otherwise
supportive environment an enterprise provides to workers to support or motivate their
efforts to improve or maintain healthy personal lifestyles, as well as to monitor and
support their physical and mental health¹

Awareness / prevention, risk identification / prioritization, and targeted support

Disease management
¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010
http://www.who.int/occupational_health/publications/healthy_workplaces_model.pdf
Defining a Healthy Workplace
Supportive psychosocial work environment includes:

Organizational culture as well as attitudes, values, beliefs and daily practices in
the enterprise that affect the mental and physical well-being of employees¹

Enshrining importance of employees in org. mission/vision/strategy


Effectively communicating this both internally & externally
Developing policies that reflect this

Management practices; walking the talk! – making people policies “real”

Understanding employee drivers, attitudes and perceptions

Work flexibility; work-life balance

“Fair work conditions" :



Work demands are reasonable
Input/decision making is maximized
Feedback & recognition are adequate
Job Satisfaction  >
Job Stress 
¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010
http://www.who.int/occupational_health/publications/healthy_workplaces_model.pdf
Defining a Healthy Workplace
Corporate Social Responsibility (CSR) includes:
 The activities in which an enterprise might engage, or expertise and resources it
might provide, to support the social and physical wellbeing of a community in which it
operates. This particularly includes factors affecting the physical and mental health,
safety and well-being of workers and their families¹

Examples



Supporting community health awareness/prevention campaigns/initiatives
Environmental awareness/practices
Providing leadership, expertise and support related to comprehensive workplace health to
other businesses
Implications for organizations: providing opportunities for employees to
participate in CSR activities (e.g. Habitat for Humanity) can enhance
employee engagement in addition to supporting the organization’s CSR
strategy and benefitting the community
¹Healthy workplaces: a model for action- For employers, workers, policy-makers and practitioners, WHO 2010
http://www.who.int/occupational_health/publications/healthy_workplaces_model.pdf
Primary Drivers of Comprehensive
Workplace Health

2 key elements essential to successfully implementing and sustaining actions that
support all 4 elements of comprehensive workplace health
1.
Leadership


1.
Creating and facilitating an environment in which all employees can work together towards
optimal employee health and organizational performance
Should occur at all levels
Employee Engagement


Satisfaction: The level of contentment or passion a person associates with his or her
job/position and the organization
Commitment: Inspiration to do one’s best work; to perform at levels beyond what is expected,
while making a meaningful commitment to improving one’s personal health and enhancing
organizational performance
Adapted from Ontario Healthy Workplace Coalition Healthy Workplace Model ,2010
Healthy Workplace – Who Cares?
The Stakeholder
Outcomes They Care About

HR

Engagement,
Health costs

Finance

Positive ROI,
Profitability

Occupational Health

Employee health, Absenteeism

Operations

Productivity & Performance

Sales/Marketing/Customer Service

Sales, Customer satisfaction / loyalty

Executive

Profitability, Attraction/retention, CSR

Labour

Member satisfaction, health & well-being

Each employee

Health/well-being, Stress

Government

Population health, Labour productivity
healthcare cost trend

Community

Contribution to community benefit;
improved community well-being
(enhanced reputation)
MEASURING OUTCOMES
Healthy Workplace Outcomes
Measurement- Guiding Principles
1.
Understand your organization’s key issues & cost drivers that impact employee health/well-being
 Determine key benchmark measures & establish baseline
2.
Include qualitative measures (e.g. how employees say they manage their health) as well as
quantitative
3.
Consider both lagging and leading indicators
4.
Determine desired objectives/outcomes; establish linkages between outcomes where possible at
outset & factor into evaluation methodology
5.
Evaluate at identified milestones on an ongoing basis
6.
Standardize and align data requirements across all relevant vendors where possible
7.
Compare where possible to relevant norms – Canadian, industry specific, etc.
8.
Link to external best practice standards such as BNQ¹/GP2S, NQI, etc.
BNQ¹: Bureau de Normalisation du Québec: BNQ 9700-800 norm: "Healthy Enterprise"
Prevention, Promotion and Organizational Practices Contributing to Health in the Workplace
Healthy Workplace Outcomes Measurement Lagging Indicators of Health
The “economic burden” of illness and injury –
defined costs spent on events that have already
occurred








Health & drug claims
Absenteeism
Short/Long Term Disability
EAP utilization
Accidents
Turnover
Productivity
Profitability
Outcomes Measurement –
Leading Indicators of Health (Measuring Risk)
Leading indicators of health are predictive of
health issues and therefore predictive of health
claims and other issues to come











Physical Activity
Obesity
Tobacco Use
Substance Abuse
Stress / Resilience
Environmental Quality
Access to Health Care
Engagement
Health management attitudes / habits
Presenteeism
Customer satisfaction/loyalty
Population Health Trends

Diabetes: Economic burden of Diabetes is currently $12.2bln (2X 2000 level) –
projected to rise to $17bln by 2020 – Canadian Diabetes Association 2010

Cancer: Costs are doubling every 2-3 years. The model of cancer care is that of
adding-on to existing treatments. Rarely does a new therapy substitute of an older
one. In ON, cancer drugs cost $22.9mln; $79.1mln in 2006 – Report Card on
Cancer, 2007

Obesity: Employees with BMI>40 vs. recommended weight:
 Lost workdays per 100 FTE’s - 183 vs. 14
 Medical claims costs per 100 FTE’s - $51,091 vs. $7503
- Obesity and Workers Compensation; Arch Intern Med; Apr. 2007
Implications for organizations: How many of you measure the direct
impact of diabetes, cancer and obesity on your organization? Do you
consider the indirect impact on overall taxes of those costs which are
covered by the public health system? Do you assess cost
competitiveness versus other countries where a greater proportion of
these costs are borne by the private sector?
Why Link Workplace Outcomes?

Well-being-Absenteeism link: Actual work time lost for personal reasons increased
from 7.4 days per worker in 1997 to 9.7 days in 2006 – Statistics Canada 2007

Engagement-Absenteeism link (1): For every 100 workers, 47 disability days
reported for “Very satisfied” workers vs. 129 disability days for “Not at all satisfied”
workers – Unhappy on the Job, Health Reports 2006

Engagement-Absenteeism link (2): High-engagement organizations: 6.38
absenteeism days/year per employee; lower engagement organizations: 12.89 days
- Best Employers in Canada, Hewitt 2009

Wellness-Sick days link: Dow Chemical - Of those who participated in moderate or
intense weight management intervention, the average number of lost work days due
to illness decreased from 3.9 days in 2006 to 3.4 days in 2007 - Emory University
Rollins School of Public Health, 2009
(More) Why Link Workplace Outcomes?

Engagement - Well-being link: Sr. mgmt. interest in employee well-being is a key
driver of engagement; however, less than 10% of employees agree that senior
leaders treat employees as vital corporate assets – Global Workforce Study, Towers
Watson, 2008

Engagement - CSR link: 53% of employees would take a pay cut to work for an
employer with a reputation for caring about employees and the community – Kelly
Services survey (7,000 employees), 2009

Wellness-Engagement link: 45% of Americans in small-medium sized companies
would stay at their jobs longer because of employer wellness programs; 40% were
encouraged to work harder and perform better; 26% missed fewer days of work by
participating in wellness - The Principal Financial Group , Well-Being Index, 2009
Workplace Health & Well-Being –
an Outcomes Framework
Safe & Healthy
Work
Environment
“Health” Metrics
- Absenteeism /
Presenteeism
- Attraction /
Retention
- Health benefits
cost
Physical Work
Environment
Health & Safety
Process
Working
Relationships
Supportive
Psychosocial
Work
Environment
Leadership/
Manager
Effectiveness
Physical Health
Awareness/
prevention
• Musculoskeletal
•Energy
•Safety
performance
Employee
health/
well-being
Social Health
•Trust
•Fairness
•Connectedness
Employee
involvement in
CSR
Health & Safety
Culture
Business Metrics
- Productivity
- Customer
satisfaction / loyalty
- Financial
performance
Personal
Health/Lifestyle
Resources
Risk identification
tools/ targeted
support
Psychological
Health
•Stress
•Overall health
•Control
Corporate Social
Responsibility
Personal Growth
& Aspiration
Linking drug and disability data an example of a broader outcomes approach

In a 3-year study of employees with rheumatoid arthritis*, the researchers found that:
 Higher employee out-of-pocket payments may lead to lower medication
adherence


As members’ out-of-pocket costs increased by $20 above the baseline, there was a
35% decrease in the percent of the population filling at least one prescription
People who adhered to their medication had fewer incidences and shorter
durations of short-term disability claims


For members who did not fill a prescription, STD incidence rate was 36%, compared to
23% for members who filled at least one prescription
Members who did not fill a prescription averaged 5 days longer STD duration than
members who did fill a prescription
* Integrated Benefit Institute, Research Insights- “The Blind Man and the Elephant” , 2007
Implications for organizations: plan design and pricing decisions must
consider the impact on the full spectrum of programs, taking into account
integrated data and metrics; in the above example, the benefits strategy
would logically include promoting medication adherence
GENERATING OUTCOMES
Workplace Health & Well-being –
A Continuum & Planning Framework
Well
At Risk
Chronic Conditions
Acute Conditions
E.g., low risk, good nutrition,
active lifestyle
E.g., inactivity, high stress,
overweight, high blood
pressure, smoker
E.g., prevalent diseases and
chronic conditions
E.g., respiratory, strain and
sprains, lacerations
Catastrophic
Conditions
E.g., severe burns,
premature infant, head injury
Opportunities for Integrated Prevention/Care Management Interventions
Health Promotion
Health Risk
Management
Disease
Management
Self/Professional
Care
Case Management
Community-based programs
(awareness/prevention)
Targeted health risk
assessment
Patient identification
and enrollment
Self-care triage tool
Utilization management
Immunizations
Targeted behavior modification
(e.g. health coaching)
Behavioral and clinical
support
Telephonic//Econsults/Clinician visit
Disease-specific
Case management
Stress/mental health
management
Care coordination
Post- decision support
Care coordination
Community-based programs
(risk-specific)
Address co-morbid conditions
Occupational health and
safety
Social support
Health ScreeningHRA & biometrics
Health information resources
“Preventable illness makes up approximately 70% of the burden of illness and its associated costs.
Well executed health promotion programs can show savings of up to 20% in the first year.”
- Dr. James Fries, Beyond Health Promotion: Reducing the Need and Demand for Medical Care, 1998
34
A Word About Chronic Disease

When employees suffer from chronic diseases, organizations can experience lost
productivity and lost opportunities, e.g.:







increased employee absenteeism;
increased disability;
increased accidents;
reduced workplace effectiveness; and
negative impacts on work quality or customer service¹
Globally, mortality from chronic disease is about 56 percent of all deaths among the
working-age population and is the main factor behind lost work time in this group²
Businesses have a vital role in the prevention and management of chronic diseases,
and also in helping their employees—who live with chronic conditions—to enjoy a
high quality of life, and work productively. This role is critical to individual health and
well-being, firm-level success, sector performance and, ultimately, the overall
prosperity of Canada³
¹World Economic Forum, Working Towards Wellness: The Business Rationale, (Geneva: World Economic Forum, 2008
² World Economic Forum, Working Towards Wellness: The Business Rationale (Geneva: World Economic Forum, 2008
³ Addressing Chronic Diseases-What’s Business Got to Do With It?, The Conference Board of Canada, Sept. 2010
CWH Implementation Process
Take Stock
1.


Monitor: Identify & assess key workplace health issues
Measure: Gather available data or measure using relevant tool
Report: Identify gaps and review results with relevant stakeholders
Take Action: Develop a healthy workplace strategy and implement a plan to best
address the needs and gaps identified in taking stock phase


3.
Evaluate
Take Stock: Monitor, measure, and report data that reflects workplace health and
organizational performance

2.
Take Action
Plan: Set goal and identify programs, processes or policies needed; develop action plan
Act: Implement action plan
Evaluate: Evaluate outcomes and report on effectiveness and impact of the plan


Evaluate: Use tools to evaluate process, determine if plan has been fully implemented, and
if goals have been met
Revise: Identify what should be continued, stopped, or revised. Start CWH implementation
process over as necessary.
Adapted from ON Healthy Workplace Coalition Healthy Workplace Model 2010 ADD LINK
Generating Outcomes –
Emerging Opportunities


Emergence of effective tools to measure costs & identify outcomes opportunities
More wellness offerings by mainstream workplace health service providers - but
often not seamlessly linked to core offering (e.g. Life/health carriers –
wellness/prevention)




Need greater integration of traditional services (e.g. proactive referral of STD/LTD
claimants to EAP)
Need greater integration of new/emerging workplace health/wellness services with each
other AND with existing services (e.g. synch HRA and biometric screening initiatives and
link results with flex benefits enrollment process)
More emphasis on disease management – new entrants to workplace health
market
Employer coalitions
Generating Outcomes –
(More) Emerging Opportunities


Employee health/well-being as part of Corp. Social Responsibility (CSR) strategy
Workplace health common standards & model




e.g. ON Healthy Workplace Coalition
Certification – GP2S, NQI, etc.
Multi-stakeholder collaboration – all workplace health stakeholders
Measure societal impact of workplace health initiatives (e.g. utilization of public health
resources)

Can help to provide the business case for government to consider incentives for workplace
health improvement
Conclusion

The good news: Considerably greater business emphasis on the importance of
employee health and well-being

The challenge/opportunity:: Health/well-being to become “way of doing business”;
heightened emphasis on evaluation and generating outcomes; health indicators will
increasingly be linked to key organizational drivers

Caution: Health/well-being resources, programs & initiatives that do not
demonstrably enhance key organizational drivers will become superfluous
Next Steps- Employer Survey




Several reports have been published with respect to WHP programs
amongst Canadian employers
Initial phase - reviewed existing WHP literature
Next – Employer survey to better understand information on WHP initiatives
that are emerging or otherwise not found in literature review
This survey and case studies will add to the current body of knowledge by
assessing:





What health and wellness metrics are used in program evaluation?
How are health metrics related to specific employee productivity metrics?
Are WHP programs being developed/modified in response to specific issues
identified through a process to assess employee health issues/needs?
What is the ROI of given WHP programs?
Do incentives play an important role in employee participation? Are incentives
evolving beyond awareness towards “taking action”
Survey – a call to action



Selected Canadian employers were initially asked to participate in the
survey in Summer 2010
Survey now ready for broader distribution
Learning opportunity:



subset aggregate report for HW&W Conference attendees
participants will have access to survey results to help inform dialogue on WHP going forward
The survey as well as background and contact information is available at:
http://www.biomedcom.org/en/whpstudy/
• you can take more than one session to complete
the survey; remember to Save before Logging
Out
• when you have completed the survey, check
Survey Completed, click Save, and then
Logout
Survey – early returns

Program Evaluation:


Nearly ¾ of responding employers formally evaluate their programs
 health metrics, outcomes – yes
 ROI – not measured
Incentives:
Nearly all employers surveyed provide incentives for participation…
 …more than ½ provided incentives for TAKING ACTION


While at HW&W please visit the Internet Café and complete
your survey on the spot!

If you have any questions concerning the WH survey or any aspect
of this presentation, please contact Peter or Allan at:
peter_melnyk@biomedcom.org
asmofsky@cogeco.ca