missing link in workplace wellness culture
PSE for integration of wellness into culture
today’s session
programming vs. PSE
defining culture
6 sources of influence
working well
PSE strategies for
integrating wellness
into culture
 implementation
examples
 contacts
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programming vs PSE
 what is programming?
 awareness
campaigns
 education sessions
 screenings
 challenges
 participation based
activities
 what is PSE?
 flex time policy for
physical activity
 tobacco free campus
 ID tobacco users,
refer to resources, F/U
 healthy food option
every time food is
served
 walking trail
 POD prompts at
elevators/stairs
 wellness in org
strategic plan
 benefit/incentive tie-in
audience response
 does your organization have written wellness
policies?
 yes
 no
 we have practices but not written policies
why policy?
 what purpose do workplace policies serve?
 policies exist to shape behavior
 health policy shapes health behaviors
 not an elimination strategy
 provides choice (evidence based)
 access, marketing, education, environment, and
benefit structures make healthy choice easy choice
 most prominent, easily identifiable, most affordable
 policy ensures practice is universal and sustainable
 policy sets up systems that are supported by
environment…creates culture
defining culture
what is culture?
 “Culture refers to the social forces that shape
behavior and beliefs through norms, support,
modeling, training, rewards, and
communication.”
 Achieving a Culture of Health. Health Enhancement
Systems. 2008.
 “How things get done around here”
 Bob Allen
what is a culture of wellness?
 focuses on the organization, not just the individual
 makes wellness a part of your organizational
structure and your day-to-day operations
 wellness becomes a part of the fabric of the
organization
 a comprehensive approach that focuses on policy,
systems, benefits, and environment to support
healthy living
 fills the gap between stated values and how things
actually get done
 defines the employee experience
key components of a culture of wellness
missing link in worksite wellness
HRA + Indiv
feedback
Programs &
Campaigns
Benefits & Incentives
Policy & Environmental Support
mixed messages
SABOTAGE
audience response
 does your organization’s strategic plan include
employee health/wellness goals?
 yes
 no
evidence based best practices
 employee wellness in multi-year strategic plan
 impacts bottom line
 key strategy for achieving mission and vision
 establish clear goals and metrics for wellness
 monitor at least annually
 offer preventive benefits to employees and
dependents
 ensure that senior leaders have visible roles in
wellness
 use cost vs. ROI, comparison to peers, current employee
health status, competitive advantage potential to gain
interest and buy in
evidence based best practices
 allocate funding for wellness into budget
 creative funding strategies
 identify free community resources
 include employee wellness in the job description
of at least one employee
 build a wellness committee
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diverse and representative
all levels and key departments
meet regularly
assess, plan, implement, communicate, evaluate
wellness efforts
evidence based practices
 allow employees to attend wellness activities
during work hours
 incorporate wellness goals into job performance
criteria of key staff
 HR, senior leaders, wellness staff
 accountability/responsibility
 conduct an annual health risk assessment
 use aggregate data to tailor efforts
 use trend reports to justify efforts to leadership
 conduct an annual employee interest survey
evidence based practices
 measure impact of wellness on health care costs
 medical and pharmacy
 measure impact of wellness on productivity
 short/long term disability
 work comp
 sick leave
 measure the direct impact of wellness initiatives
on employees
 process measures- participation rates, health behaviors and
outcomes, etc
 evaluation demonstrates value
 measure what you treasure and treasure what you
measure- Melva Fager Okun, PhD
promising practices
 consistently communicate wellness policies,
programs, and benefits
 multi channel, multi modal communication several times
a year
 “stealth benefits” benefit no one
 assess community for local resources
 maximize free resources (hospitals, AHA, ESMMSC)
 appoint wellness champions to promote
wellness initiatives
 throughout departments and locations
 increases socials support and promotion
general recommendations
 communicate the value of wellness to your
employees
 include in annual benefit statement to employees
 consider offering incentives for participation,
progress, or outcomes
 assess what will work for your population
 tie to proper use of benefits or healthy behaviors instead
of random cash or gift cards
 recognize and reward wellness champions
 big impact, no cost
 letter from CEO, success story in newsletter, etc
creating a culture of wellness helps you …
 achieve consistent
communication
 align activities with
stated values
 make the healthy
choice the easy choice
 increase employee
engagement, drive
intrinsic motivation and
peer support
 move from siloes to a
comprehensive
approach
 enhance and sustain
existing efforts
 be an example to the
community
 invest in human capital
 create a healthier, more
productive and energized
workforce
 enhance outcomes
 create a competitive
advantage
 impact entire workforce
personal…and organizational wellness
impact of culture
wellness = optimal health
not the absence of disease
audience response
 why is health behavior change so difficult?
 lack of willpower
 lack of skill
why is change so difficult?
is it
will?
or
skill?
the willpower trap
 know-do gap
 simplistic view of willpower is wrong and
incomplete
 teach skills for willpower to accept
delayed gratification- Bandura
 mastering temptations is more than
personal motivation, skill plays an
important role
 primary problem isn’t weakness, its
blindness (to sources of influence)
 if blind to why we succeed, we can’t
prevent failure
STRUCTURAL
SOCIAL PERSONAL
six sources of influence
MOTIVATION
ABILITY
1
2
3
4
5
6
1- personal
motivation
2- personal
ability
3- social
motivation
4- social
ability
5- structural
motivation
6- structural
ability
blind and outnumbered
 scientist & subject
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
know your own
influences
find crucial
moments and turn
into vital behaviors
 keep it real
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act on them…
or be acted on by them
tell whole vivid story
invalidate excuses
 accomplices to
friends
 control your space
 control sources you
can see
 engage all 6
sources of
influence
six sources of influence
STRUCTURAL
SOCIAL PERSONAL
MOTIVATION
ABILITY
1
2
3
4
5
6
1- personal
motivation
 crucial moments
 vital behaviors
 interrupt impulses
by connecting
with goals
 inspiring quotes
 personal
motivation
statement
 tell the whole
vivid story
six sources of influence
STRUCTURAL
SOCIAL PERSONAL
MOTIVATION
1
ABILITY
2
2- personal
ability
 do what you can’t
 skill scan
 deliberate practice

3
4


practice for crucial
moments
break into small
pieces
prepare for
setbacks
 learn the will skill
5
6
six sources of influence
STRUCTURAL
SOCIAL PERSONAL
MOTIVATION
ABILITY
1
2
3
4
3- social
motivation
 bad habits almost
always a social
disease
 accomplices to
friends


5
6

accompliceentice/enable
unhealthy behavior
friend- fans and
coaches
transformation
conversation
six sources of influence
STRUCTURAL
SOCIAL PERSONAL
MOTIVATION
1
ABILITY
2
3
4
5
6
4- social
ability
 redefine “normal”

Beware of the
“everyone” excuse
 transformation
conversation
 distance yourself
from the unwilling
 add new friends
six sources of influence
STRUCTURAL
SOCIAL PERSONAL
MOTIVATION
ABILITY
1
2
3
4
5
6
5- structural
motivation
 environment
 invert the
economy to
subsidize/reward
good habits
 loss aversion

higher premium on
loss than on gain
 reward in
moderation and
combination

link to
personal/social
motivation
 reward small wins

process goals
six sources of influence
STRUCTURAL
SOCIAL PERSONAL
MOTIVATION
1
ABILITY
2
6- structural
ability
 environment
 build fences
 manage distance

good close and
convenient, bad
distant and difficult
 change cues
3
4

 engage autopilot

5
6
visual reminders of
vital behaviors
during crucial
moments
structure good
choices with
standing
commitments
 use tools
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apps
equipment
 control your space
will you act on them…or will they act on you?
personal and organizational wellness
 what do you want to change, personally?
 what changes needs to take place in your
organization?
 will you be an accomplice or a friend?
audience response
 realistically, what % of the employee
population can you hope to reach with a
comprehensive wellness strategy?
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40%
55%
80%
100%
working well
 effective cross-sector strategy implementing key components of
healthy eating & active, tobacco free living in worksites,
establishing cultures of wellness where the healthy choice is
the easy choice
 organizational commitment to integrate wellness into strategic
plan, changing the employee experience
 investment in human capital; most valuable asset
 seamless integration with programming and chronic condition
management
 aligns policy and environment with desired health behaviors,
creating support for and likelihood of healthy choices
 PSE implementation impacts all employees whereas
programming only impacts those who choose to participate,
often missing those who need it most
 creates consistent message throughout org that healthy
behaviors are supported and expected
cost of doing nothing
Cost/Business
of 100
Employees
Behavior
% in SC
Cost/
Employee
Smoking
21.6%
$5,800
$125,280
Overweight/Obesity
67%
$2,676
$179,292
Physical Inactivity
50%
$1,984
$99,200
$10,460
$403,772
TOTAL
CDC Office of Smoking and Health, Smoking Attributable Morbidity, Mortality, and Economic Costs (SAMMEC), 2002.
Be Active North Carolina, Inc., The Economic Cost of Unhealthy Lifestyles in North Carolina, 2005.
investing in wellness
Avg. Cost Savings of a Comprehensive Worksite Wellness
Program
Health Care Costs
26% reduction
Absenteeism
27% reduction in sick leave
Disability/Worker’s Compensation
32% reduction

$3-$1 avg. savings-to-cost ratio of implementing a
comprehensive worksite wellness program
Partnership for Prevention. Leading by Example: The Value of Worksite Health Promotion to Small and Medium Sized
Employers, 2011. http://www.prevent.org/data/files/initiatives/lbe_smse_2011_final.pdf

investing and ROI
 invest in human capital (your most valuable asset)
 salary/benefits often more than 60% annual cost to do
business
 reasonable ROI expectations comparable to other capital
investments
core elements of working well
 executive leadership
 strategic partnerships
 detailed & tailored
technical assistance
 mapping of progress &
success
 celebration & recognition
goals of working well
 assist worksites to
assess, implement, and
maintain evidencebased and effective
policies designed
around the three pillars
of an effective worksite
wellness culture:
 tobacco-free people and
places
 delicious and affordable
healthy food environments
 access and opportunity for
physical activity during the
workday
 implement low/no cost,
effective wellness
policies, systems,
environments and
benefits that help ALL
employees live healthier
lives
 identify missing wellness
opportunities
 align current efforts
 evaluate progress
 sustain wellness culture over
time
working well resources
WHA assessment
recs/action plans
online toolkits
webinars
workshops
sharing/learning
network
 site visits
 individual, customized
assistance
 working well and
prevention partners
staff
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implementation strategies for excellence
tobacco cessation systems
healthy food environments
worksite of active employees
tobacco free people and places
 help every employee lead a
tobacco-free life
 key components:
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policy
system approach
benefits
incentives
evaluation
 key components quit tobacco system
 policy
 100% tobacco free property wide
 consistent enforcement
 communicate policy to employees; empower
employees to approach violators
 adequate signs throughout property
 system approach
 ID tobacco users (HRA/attestation)
 assess readiness to quit, refer to multiple
resources, f/u often
 benefits
 counseling, OTC NRT insurance benefit or
equivalent, FDA RX meds on formulary
 multi-channel communication & promotion of
benefits (employees & covered spouses)
 incentives
 incentives for tobacco free emp
 disincentive for tobacco using emp (motivate
quit)
 incentives for enrollment in quit tobacco
program
 evaluation
healthy food environments (HFE)
 provide access to
delicious, affordable
healthy items in all
worksites
 key components:
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
access
pricing
marketing
benefits
education
 key components HFE

access

pricing

marketing

benefits

education
 adopt healthy food nutrition criteria
 implement a healthy food policy requiring healthy options
whenever/where ever food provided
 ensure vendors provide healthy options all hours of
operation
 train food service staff on prep & portion control
 partner with local farmers or CSA’s
 onsite gardens
 use pricing structure to incentivize purchase of healthy
options
 increase price of unhealthy
 point of decision nutrition info
 identify foods meeting healthy nutrition criteria with
consistent icon
 use product placement to make healthy options more
prominent and accessible
 provide nutrition counseling to all employees as insurance
benefit or benefit equivalent
 use benefit design & wellness incentives to encourage
behavior change
 constantly communicate benefits and equivalents to
employees and covered spouses in multiple formats
 implement HFE promo campaign
 lunchNlearns, cooking demos, evidence based weight mgmt
worksite of active employees
 create a culture where
being active is the
easy norm
 key components:




policies
environment
education
benefits & incentives
 key components active worksite

policy

environment
 use PA resources on clocked time
 paid work time set aside for PA
 flexible work hours to allow PA before, after, lunch
time
 encourage paid break use for PA
 consider culture of wellness & safety policy combo
 access to PA facilities/equipment during/after work
hours
–
walking trails, workout video library
–
access to bike racks/showers
–
“sit and be fit”- PMC
 encourage alternate commutes
 accommodations for special needs

education
 point of decision prompts
–

elevators, stairs, break rooms, etc
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
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
communicate policies
consistent messaging
promo campaign of PA resources
management lead walking mtgs
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
discount access to local or onsite fitness facilities
onsite classes at low/no cost
insurance benefits that support PA
communicate benefits & equivalents
promotion of benefits & incentives through wellness
programming
benefits & incentives
MUSC board of trustees resolution
beaufort jasper water sewer authority
GOAL 4: HEALTH AND SAFETY
Provide an environment that supports the physical and psychological well-being of all our human
resources.
4.5 Develop a comprehensive wellness program—initial plan stages
4.5.1 Design and support a sustainable wellness team structure and function
Organize and create an employee driven wellness team that has the capacity to sustain itself on a volunteer basis;
leverage resources for Wellness activities and events and advocate for system-wide wellness improvements
 Establish a communication process that effectively recruits and keeps Wellness Team Members informed of events,
activities, progress and meetings
 Name the program and compile ideas for marketing it to employees—align policies and procedures to support
initiatives (Logo/Slogan Contest)
 Develop, track and report on the achievement of the Wellness Annual Work Plan. Specifically, track the impact of
wellness activities on health care costs, employee productivity (short and long term disability, workers compensation
claims and sick leave) and employee participation rates
 Based on projected first year plans, secure budget to support goals and revise for subsequent years as the program
evolves
 Creatively use the Employee Newsletter to engage employees, celebrate successes and spotlight wellness
4.5.3 Promote health and wellness at BJWSA to our employees, leadership and visibly participate
in promoting wellness to the public (Culture of Wellness)
Create a dynamic marketing program designed to build awareness, engage employee involvement and promote the value
of wellness to employees, leadership and the greater public
 Create a wellness homepage on the company intranet or sharepoint (if available) that displays Wellness Mission and
Values, Wellness Team members and existing programs with links, access from home and email response capability
 Present the new Wellness Program to the Board of Directors
 Communicate the value of wellness benefits to employees through the annual Total Compensation Statements
 Implement healthy food (and beverage) policy (including approved vendors) and ensure healthy options are available fruit baskets/farm boxes
mars, inc- scorecard for executives
practicing what we preach @ scha
initial assessment…
 physical activity
 nutrition
 tobacco
implemented strategies
F
D
D
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

3 years later…
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
physical activity
nutrition
tobacco
culture
policies
tobacco, nutrition, physical
activity
environment

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
onsite fitness classes (WoW)
onsite walking trail
no junk food dumping
CSA
farmer’s market


executive support
multi-channel
communication
A+
A
A  system

diverse & representative
A
wellness committee

branded wellness program



benefit incentive
onsite screenings
health coaching
SCHA policies & standards of behavior
 culture of wellness policy
 tobacco
 nutrition
 physical activity
 standards of behavior
 tobacco
 nutrition
 physical activity
 nutrition criteria on and
offsite events
 liability waiver for activity
 annual tobacco
attestation
 surcharge and requirement
for cessation to earn benefit
incentive
wellness in SCHA strategic goals & priorities
best practices
culture of wellness:
 promote and implement a tobacco-free environment
with a comprehensive tobacco cessation system,
delicious and affordable healthy food environment, and
opportunity for physical activity during the work day
 provide excellent preventive benefits, supported by
policies, and consistent throughout environment
 executive-level endorsement with communication to
management and staff
 consistent messages and enforcement
 comprehensive wellness team/committee
 incorporate “6 sources of influence”
 Patterson, Grenny, Maxfield, McMillan, Switzler, Change
Anything- The New Science of Personal Success, 2012.
www.changeanything.com
final thoughts
 policy sets up systems, supported by
environment…creates culture
 PSE impacts 100% of workforce
 creating a culture of wellness is about population health,
starting at the top and impacting entire organization
 culture should support, not sabotage, workplace wellness
programs
 approach organizational health from a strategic
perspective
 workplace culture is part of a larger, integrated health
and productivity strategy
 organizational health can be a competitive advantage
 does your workplace culture support or sabotage?
 are you an accomplice or friend
Working Well Staff- SCHA & Prevention Partners
Jen Wright, Program Director, Working Well
SCHA • 803.744.3553 • jwright@scha.org
Stephanie Hudson, Program Business Manager, Working Well
SCHA • 803.744.3531• shudson@scha.org
Emily O’Sullivan, Program Manager, Working Well
SCHA • 803.454.6969 • eosullivan@scha.org
Lindsey Bickers Bock, Prevention Partners
919-969-7022 x225 • lindsey@forprevention.org
www.scha.org/working-well
www.twitter.com/SCHospitals
#workingwell
www.facebook.com/schospitals
www.ncpreventionpartners.org
www.twitter.com/ncprevention
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