After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM’s Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM’s Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership’s engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
The ACSM’s second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers’ compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware’s comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees’ changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees’ unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization’s population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people’s health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work–life balance, create a less stressful work environment, and increase individuals’ sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.