Employee Health and Wellness

Changing health-related behaviors is a difficult challenge. Incorporate the tools below into your Wellness initiatives to assist members in successfully changing health behaviors.

Tool #1: Set effective goals
 • Focus on areas that can impact the overall goal.
  • For example, if the overall goal is to lose weight, the most productive areas to focus on are the dietary and activity changes that will lead to long-term weight loss.
  • For example, stress management and improving self-esteem may also impact weight loss; however, improving relationships, while a worthwhile topic, will not necessarily impact weight loss.
 • Make the goals specific, attainable, and forgiving. For example:
  • “Exercise more” is too general.
  • “Walk five miles everyday” is specific, but may not be attainable.
  • “Walk 30 minutes everyday” is specific and more attainable, but is not very flexible.
  • “Walk 30 minutes, five days a week” is specific, attainable, and forgiving.
 • Use a series of short-term goals to achieve the ultimate goal.
  • Short-term goals break big challenges into more easily attained pieces.
  • Smaller steps also provide Employee Health Promotion Program members with encouragement and success. These small successes are essential for maintaining motivation towards a long-term goal.

Tool #2: Increase self-awareness
 • Self-monitoring is useful for tracking behavioral and environmental cues that trigger a particular health behavior.
 • Keeping track of health behavior status is also useful for times when progress towards a goal is difficult to measure, or when an individual is in a maintenance stage.

Tool #3: Offer rewards and motivation
 • Encourage members to reward themselves for achieving small successes on the way to their ultimate goal.
 • Remember that rewards don’t always have to be “things.” Words of encouragement and praise can provide powerful motivation when spoken by a teacher, instructor, parent, friend, etc.

Tool #4: Respond effectively to set-backs
 • health behavior change is conceptually a continuum. However, movement along that continuum is not just in one direction. People can move backwards or forwards or sometimes just stay put. Communicate to members that set-backs, lapses and even staying the same (i.e., maintenance) are common for individuals trying to change behavior.
 • Stress is frequently a factor in lapses and relapses. Offer a variety of stress management resources to help members better handle the stress which could trigger a set-back.
 • Brain storm to create a list of potential (and probable) barriers to participant behavior change. Then formulate strategies to meet each of those challenges.
 • Improved time management and decision-making skills can be effective ways to overcome behavior change relapses.
 • Offer members with information regarding the behavior change process so that they will be better prepared for the challenges they will face. A brief overview of the Stages of Change may be helpful.

Most employers do not have the Employee Health Promotion Program resources to address all of their health needs at once. Priorities must be set to determine the most pressing health needs. Use the steps below to prioritize installation Wellness needs.

Assess the health needs of the population.

Collect information about the health needs in the community. How?

• Community- or target group-specific surveys

Identify health needs and at-risk populations.

Use the information to identify leading health needs and also high risk populations. For example:
 • Obesity and overweight
 • Injury prevention
 • Self care 

Reduce the list.

Not every health need can (or should) be addressed. Use the following questions to determine which health needs should be addressed first.
• How does the health need impact operational readiness? How big is the impact?
• What are the Senior Management priorities? How does the health need fit into those priorities?
• What are the behavioral factors affecting the health need? What is the evidence that a behavior change will make a difference? Has the behavior been successfully changed by other Employee Health Promotion Programs?
• What other social, physical, or environmental factors influence the health need or the target population?
• Is the health need a greater problem at the local level than in the U.S. population as a whole?
• Does the employer have the subject matter expertise and resources to address the health need?

Develop Employee Health Promotion Program recommendations.

Only a handful of specific health needs should be focused on in a given year. Keep the following in mind as recommendations are developed as to which specific health needs will be addressed:
• Avoid duplication of other ongoing Employee Health Promotion Programs whenever possible. Identify Employee Health Promotion Programs already addressing the health need and/or the target population.
• Identify and assess available resources. Build on existing services whenever possible.

Use the recommendations to offer tailored, targeted, integrated initiatives to address the prioritized list of health needs. Prioritizing health needs will keep Employee Health Promotion Programs focused, maximize efficient use of resources, and align Wellness efforts with Senior Management goals and priorities.

References
• US Department of Health and Human Services, Planned Approach to Community Health, http://www.cdc.gov/nccdphp/publications/PATCH/index.htm.
• Implementing a Comprehensive Community Wellness and Well Being Program, presentation by CHPPM-EUR at the 2006 Force Health Protection Conference

Keeping the bottom line up front Bottom Line Up Front in Employee Health Promotion Program will help you get and sustain Senior Management support. A Bottom Line Up Front approach will also help you more realistically measure the impact of your Employee Health Promotion Program.

The bottom line in Employee Health Promotion Programs answer two key questions:
 • How will participant health be improved?
 • What’s in it for Senior Management?

The ultimate bottom line: all roads should lead to readiness.
 • Always be ready to communicate to leadership the ways that your Employee Health Promotion Program impacts readiness.
 • Think like Senior Management: what Employee Health Promotion Program outcomes will be important from a Senior Management point of view?
 • Develop line-centered language that communicates those outcomes.
 • Ask members how they think a particular Employee Health Promotion Program enhances force readiness. This input is a valuable source of information.

Use the following steps as a Bottom Line Up Front approach to Employee Health Promotion Programs.

Step 1: Think about the end of the Employee Health Promotion Program first and plan backwards.
 • It has been said, “If you don’t know where you’re going, any road will get you there.”
 • Before planning or beginning any part of the Employee Health Promotion Program, be able to answer the questions: how will participant health be improved? What’s in it for Senior Management?

Step 2: Identify concrete Employee Health Promotion Program outcomes.
 • Identify up front what the Employee Health Promotion Program is working towards.
  o For example: will members lose weight? Walk more steps? Decrease injuries? Move to another stage of change?
 • Identify any processes or procedures that will be improved.
  o For example: which pharmacy operations will become more efficient? How will record-keeping be streamlined?

Step 3: Determine what will be measured to show that Employee Health Promotion Program goals were met.
 • Look at what information is really needed to show Employee Health Promotion Program effectiveness. Avoid the temptation to collect every possible piece of data. Choose a handful of important information points and stick to those.
 • Think backwards when determining what information to collect – consider how easily follow-up information can be collected when a Employee Health Promotion Program ends. Getting follow-up information is frequently a challenge.
 • Only collect information for health behaviors or indicators that the Employee Health Promotion Program actually affected.
  o For example: if the main Employee Health Promotion Program goal is that members will walk more steps, then it may be better NOT to choose changes in cholesterol level as a Employee Health Promotion Program outcome (unless the Employee Health Promotion Program specifically addresses cholesterol).
 • Avoid measuring outcomes that the Employee Health Promotion Program cannot (or did not) affect.

Step 4: Determine what Employee Health Promotion Program elements must be included to move members towards the Employee Health Promotion Program goals.
 • The concrete Employee Health Promotion Program outcomes identified in Step 2 are the compass for keeping the Employee Health Promotion Program on track. All Employee Health Promotion Program elements should lead towards that ultimate goal.

Working backwards when planning and beginning Employee Health Promotion Programs is really forward thinking. Keeping the bottom line up front is a smart approach to Employee Health Promotion Programs.

Health Information Technology can make the entire healthcare system more effective and efficient by enhancing:
 • Documentation (lab and test results, clinic notes, consult recommendations)
 • Communication (provider to patient, provider to provider)
 • Information input (templates to facilitate data entry)
 • Delivery of care (documenting all patient-provider interactions in a single system)
 • Chronic disease risk identification (evaluation of risk factors, recommendations for appropriate preventive services and screenings)
 • Consistent recording of correct billing codes

But, adapting to Health Information Technology is a challenge.
 • Health Information Technology almost always involves a “new system.” Consequently, the entire staff, from healthcare providers to IM/IT personnel is on a learning curve.
 • Existing IT infrastructure may not be adequate, so the Health Information Technology system may be very slow, or may frequently crash.
 • The new system may not have all the forms you need already in place. New forms may be needed.
 
Lessons learned from Health Information Technology implementation

Take advantage of as many training opportunities as possible.
 • Learn as much as you can about the Health Information Technology that you need to use. Become an expert.
 • Ask questions if you are unsure how to navigate the system.
 
Keep the big picture in mind.
 • Be aware that those keeping the Health Information Technology system up and running may have a very different set of priorities. The IM/IT staff may not see your request as a priority when it is taking all their manpower to trouble shoot the new system each day.
 • Other changes to the Health Information Technology system may be in line in front of yours, so be patient.
 
Think through changes thoroughly.
 • Take time to think through a new form thoroughly. Know exactly what you want before talking to the developer.
 • Don’t think in a vacuum. If you build a form, make sure it is one your staff will use and find efficient.
 • Make a draft version of the form and use it before requesting that it be put into the new system.
 • Be prepared to build a good case for why your form should be created. Build a stronger case if your form should be developed ahead of other requests in the queue.
 • Be patient and persistent when working with a programmer/developer on a new form. Meet frequently and set up timelines and deadlines.
 • Coordinate with IM/IT and the Health Information Technology contractor to see if they can support a new project in the required time frame.
 
For more information about Health Information Technology implementation, go to the Agency for Healthcare Research and Quality (AHRQ) National Resource Center for Health Information Technology at http://healthit.ahrq.gov.

To effectively manage your Employee Health Promotion Program resources, first determine the resources you need and the resources you have. Then develop a plan to fill the resource gaps.

What Employee Health Promotion Program resources do you need?
 • Make a list of staff members, materials, equipment, space, and logistical support.
 • Be as specific as possible.
 • Include partnerships that will be needed to make the Employee Health Promotion Program happen.

Identify available Employee Health Promotion Program resources.
 • Use materials that exist or are already on hand. Resist the temptation to start from scratch!
 • Determine what other departments already have.
 • Contact DHPW/HPPI to find out what other installations have done.
 • Know where to borrow or get free materials.
 • Use local or internal resources whenever possible.
 • Look for opportunities to cut and/or share costs.

Develop a strategy to fill Employee Health Promotion Program resource gaps.
 • Partner with as many staff members and employers as you can. Emphasize what’s in it for them.
  o Example: use a Physical Therapist to teach a back health class.
 • Take advantage of community organizations and coalitions.
 • Use volunteers as frequently as possible.
  o Red Cross volunteers, medical interns or nursing students can supplement your manpower.

Former Employee Health Promotion Program members make good guest speakers.
 • Keep a list of subject matter experts who will provide input for free so you can avoid the expense of an outside contractor or consultant.

Look for innovative Employee Health Promotion Program opportunities.
 • Other funding opportunities may exist at your facility.
  o Example: if there is a book fair, see if you can apply to receive some of the proceeds.
 • Ask the unit to contribute resources to Employee Health Promotion Programs directly started at the unit level.
 • Get to know the contracting person at your installation. They frequently know the least expensive places to obtain many different kinds of materials.
 • Look for “recycling” possibilities.
  o Example: IMD may be able to give you old computer workstations for use with electronic health assessments.

Good communication will help you find more partners and volunteers.
 • Get the word out to the community about your Employee Health Promotion Programs.
 • Describe what you are doing and how you are doing it.
 • Presentation is everything. Keep information current and use lots of visual aids.

All Employee Health Promotion Programs require resources. Some resources you will already have. Some resources you will have to find. Sometimes you will have to make something out of very little. Smart strategies can maximize your Wellness resources.

Organization processes are structured activities that achieve a specific result. For example, scheduling appointments is a employer process that results in an orderly work flow and timely patient care.

Employee Health Promotion Program implementation frequently requires changes to established employer processes. These changes may be simple, such as adding prescreening appointments to the scheduling process, or more complicated, like determining how time devoted to a particular Employee Health Promotion Program will be coded.

Not all change can be affected painlessly. However, developing a plan for achieving change will overcome barriers like:

 “But we’ve always done it that way” or “But we’ve never done it that way.”

Each change situation will be different. The path to achieving change may not always be straightforward.

Lesson learned: Making small, incremental changes will be easier than trying to make one big change. It is also easier to modify a current process than to introduce a brand new one.

Develop a road map for change.

Describe the current employer process.
 • For example: what is the current registration process for the weight management program? Include steps for both members and staff.

Identify where the new or modified employer process could fit into the current process.
 • For example, prescreening appointments for the weight management program could be scheduled when members sign up OR the prescreening could be done at the first class.

Collaborate.
 • Look at the change process to be a team effort. Determine everyone who will be affected by the change and get their input.
  o For example, be sure to ask the personnel that set up the prescreening appointments AND the personnel that would do the prescreening for their ideas.
 • Recruit one or more champions for the change. It helps if the champion has some clout.
 • Get buy-in from as many staff members as you can – including those that might be most resistant to the change.

Communicate.
 • Don’t keep the change a secret. The more staff members know, the more likely they will support a change.
 • Anticipate barriers ahead of time. Be ready to articulate concrete benefits that will result from the change – especially advantages such as costs avoided or training time conserved.

Employee Health Promotion Program evaluation is critical for effective Wellness and will help you get Senior Management support.

Why evaluate your Employee Health Promotion Program?

Employee Health Promotion Program evaluation answers these questions:
 • What change(s) occurred in the target population?
 • ‘What’s in it’ for Senior Management?
 • Are the resources that are being used worth the outcomes that are reached?
 • Were Employee Health Promotion Program outcomes expected? (Unexpected outcomes may have occurred.)
 • What Employee Health Promotion Program areas need improvement?

Employee Health Promotion Program Fact of Life:

Employee Health Promotion Program evaluation left to “chance” or until “there is time” will never happen.

 • Employee Health Promotion Program evaluation should be considered as an essential part of the whole plan for Wellness and not as something extra.

Where do you start?

Keep it simple. Employee Health Promotion Program evaluation does not have to be complicated.
• Get baseline information.
 • Baseline information is the health status of the target population at the beginning of the Employee Health Promotion Program.
 • Start by collecting just 3 or 4 key items as the baseline. You will have better success collecting follow-up information later if you only need to get a few pieces of information.
 • Don’t rely only on health indicators that require lab evaluation. Also use self-report information and health indicators that are measurable without lab tests.

• Collect information that relates to readiness.
 • You should always be ready to communicate to leadership the ways that your Employee Health Promotion Program impacts readiness. Plan ahead to collect information that will demonstrate this connection.
 • Think like Senior Management: what Employee Health Promotion Program outcomes will be important from Senior Management point of view?

• It’s never too late to incorporate Employee Health Promotion Program evaluation into Employee Health Promotion Programs.
 • If your Employee Health Promotion Program is already up and running and you didn’t plan for information collection ahead of time, start collecting information NOW.
 • If you don’t have baseline information, then collect interim information and compare that to end-of-program information.
 • Or, you can compare final Employee Health Promotion Program outcomes to similar initiatives elsewhere.

If you can’t make any comparisons to other information, use resources like The Community Guide (http://www.thecommunityguide.org/ ) that have already evaluated the effectiveness of Employee Health Promotion Program components. Compare the components of your Employee Health Promotion Program to those that have been proven effective elsewhere.

Think ahead: what unexpected challenges might come up as you implement your Employee Health Promotion Program? How could you adapt and change the Employee Health Promotion Program to meet those challenges?

• Look at the “what if’s?”
 • What if your classroom space is suddenly no longer available?
 • What if you can’t hold the Wellness Fair in the usual place?
 • Have a ‘Plan B’ (or even Plan C or Plan D) in mind for when the “what if’s” happen.

• Build a team that can help with the Employee Health Promotion Program
 • Who else could teach the health education class if the regular instructor cancels at the last minute?
 • Know what areas of expertise your staff has besides their ‘main’ job. For example, find out who has fitness instructor credentials besides just the physical therapist.
 • Don’t wait for a crisis before you build a network of staff members that you can call on.

• Be ready to roll your sleeves up
 • Jump in to fill a gap if you need to.
 • YOU may have to help restock the milk case in the dining center when the Dairy Month ‘Milk Mustache’ contest results in increased sales during lunch.

• Be willing (and ready) to respond to feedback about the Employee Health Promotion Program
 • Get participant feedback while the Employee Health Promotion Program is ongoing. Then be ready to adapt to those suggestions.
 • For example, if kids in a pediatric obesity Employee Health Promotion Program fight the idea of completing physical fitness logs, then get a verbal summary of their activity for the week instead.

• Simplify Employee Health Promotion Program
 • If part of your Employee Health Promotion Program is not working, try making that part less complicated.
 • For example, if getting follow-up information is not going the way you planned, then make the process to get information easier OR decrease the number of pieces of information that you collect.

• Use lemons to make lemonade
 • What do you do when the Employee Health Promotion Program doesn’t turn out exactly as you planned? Look for what did turn out. Often, the ‘unexpected outcomes’ produce positive results.
 • For example, one installation’s database to collect sick call data was made obsolete by a regional system. However, the installation database was able to be used in a different way to track vaccination information that improved delivery of care to Employees.
 • At another installation, world events halted a new physical training program. Instead, Employee Health Promotion Program materials were made into a fitness guide.

Take the time to plan Employee Health Promotion Programs before they are started.

Strategic planning enables better use of all your resources. Include all the steps below when you plan a Wellness activity.
• Do your homework – Locate the science and research that support your initiatives. Look for similar Employee Health Promotion Programs that already exist.
• Determine the specific health need(s) – Use these needs to target initiatives to problems that are an issue for your population.
• Organize a team – A team is a resource multiplier. Network and build as many partnerships as you can.
• Make a plan, but don’t start completely from scratch. Make a written plan for your Employee Health Promotion Program. Look for every opportunity to take advantage of resources that already exist. Don’t reinvent the wheel.
• Select a focus – Choose one or two main target areas for Employee Health Promotion Programs. Address all five stages of change in the target areas rather than trying to hit every possible Wellness topic.
• Determine your resources – What assets do you have? What assets will you need? How can you fill the gaps?
• Get Senior Management support – Think like Senior Management. Communicate the value of Wellness from Senior Management’s perspective.
• Start the activity- Be flexible. Be prepared for unexpected challenges.
• Market the activity – Keep your Employee Health Promotion Program visible for Senior Management, line and medical personnel, Employee Health Promotion Program members, and potential partners and volunteers.
• Collect and analyze outcomes – Outcomes indicate Employee Health Promotion Program impact. Start with just a few outcomes – you don’t have to collect everything. Remember that it’s never too late to start measuring Employee Health Promotion Program impact.
• Evaluate, improve and re-evaluate – Use participant feedback and Employee Health Promotion Program outcomes to determine Employee Health Promotion Program impact. Identify areas in need of improvement. Use outcomes to determine if expended resources were worth the results.

Why use small steps toward health behavior change?

Small steps give members immediate feedback on the changes they make towards better health. Measuring these small steps is also an excellent way to collect interim Employee Health Promotion Program effectiveness information.

Employee Health Promotion Program small steps make a big difference

Small steps for Employee Health Promotion Program members
• Walk to work.
• Use fat free milk instead of whole milk.
• Each day think of two things you are grateful for.
• Do sit-ups while you watch TV.
• Drink water before a meal.
• Take 10 deep breaths to relieve tension.
• Eat half your dessert.
• Skip second helpings and buffets.

Measuring small Employee Health Promotion Program steps
• Use short pre- and mid-point surveys to ask:
• How many glasses of water do you drink a day?
• How frequently you do eat fast food?
• How frequently do you skip a meal?
• How frequently do you engage in physical activity?
• How many servings of fruits and vegetables do you eat each day?

Use the results to show members how their health behaviors are changing for the better.

• Ask members to rate their health status and/or stress levels before and after an intervention.
• Add up individual (or team) steps and mark the progress on a map towards a far away destination.
• Be innovative! Do not rely only on weight loss, BMI, or cholesterol tests as health status progress indicators or health behavior change feedback.

Wise words for taking small Employee Health Promotion Program steps
 
• The first wealth is health. (Ralph Waldo Emerson)
• We are what we repeatedly do. (Aristotle)
• The victory is not always to the swift, but to those who keep moving. (CDC)
• There are 1440 minutes in every day…schedule 30 of them for physical activity. (CDC)