Posts from — November 2008

Most businesses do not have the Company Wellness 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. By way of 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 Company Wellness 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 company have the subject matter expertise and resources to address the health need?

Develop Company Wellness 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 Company Wellness Programs whenever possible. Identify Company Wellness 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 Company Wellness 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 Company Wellness 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 Company Wellness Program.

The bottom line in Company Wellness 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 Company Wellness Program impacts readiness.
• Think like Senior Management: what Company Wellness Program outcomes will be important from a Senior Management point of view?
• Develop line-centered language that communicates those outcomes.
• Ask participants how they think a particular Company Wellness Program enhances force readiness. This input is a valuable source of information.

Use the following steps as a Bottom Line Up Front approach to Company Wellness Programs.

Step 1: Think about the end of the Company Wellness 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 implementing any part of the Company Wellness Program, be able to answer the questions: how will participant health be improved? What’s in it for Senior Management?

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

Step 3: Determine what will be measured to show that Company Wellness Program goals were met.
• Look at what information is really needed to show Company Wellness 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 Company Wellness Program ends. Getting follow-up information is frequently a challenge.
• Only collect information for health behaviors or indicators that the Company Wellness Program actually affected.
o By way of example: if the main Company Wellness Program goal is that participants will walk more steps, then it may be better NOT to choose changes in cholesterol level as a Company Wellness Program outcome (unless the Company Wellness Program specifically addresses cholesterol).
• Avoid measuring outcomes that the Company Wellness Program cannot (or did not) affect.

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

Working backwards when planning and implementing Company Wellness Programs is really forward thinking. Keeping the bottom line up front is a smart approach to Company Wellness 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 Company Wellness Program resources, first determine the resources you need and the resources you have. Then develop a plan to fill the resource gaps.

What Company Wellness Program resources do you need?

• Make a list of workers, materials, equipment, space, and logistical support.
• Be as specific as possible.
• Include partnerships that will be needed to make the Company Wellness Program happen.

Identify available Company Wellness Program resources.
• Use materials that exist or are already on hand. Resist the temptation to start from scratch!
• Find out 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 Company Wellness Program resource gaps.
• Partner with as many workers and businesses 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 Company Wellness Program participants 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 creative Company Wellness 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 Company Wellness Programs directly implemented 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 Company Wellness 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 Company Wellness 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.

Company processes are structured activities that achieve a specific result. By way of example, scheduling appointments is a company process that results in an orderly work flow and timely patient care.

Company Wellness Program implementation frequently requires changes to established company 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 Company Wellness 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 company process.
• By way of example: what is the current registration process for the weight management program? Include steps for both participants and staff.

Identify where the new or modified company process could fit into the current process.
• By way of example, prescreening appointments for the weight management program could be scheduled when participants 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 By way of 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 workers as you can – including those that might be most resistant to the change.

Communicate.
• Don’t keep the change a secret. The more workers 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.

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

Why evaluate your Company Wellness Program?

Company Wellness 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 Company Wellness Program outcomes expected? (Unexpected outcomes may have occurred.)
• What Company Wellness Program areas need improvement?

Company Wellness Program Fact of Life:

Company Wellness Program evaluation left to “chance” or until “there is time” will never happen.

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

Where do you start?

Make it Simple. Company Wellness 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 Company Wellness Program.
• Begin 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 Company Wellness Program impacts readiness. Plan ahead to collect information that will demonstrate this connection.
• Think like Senior Management: what Company Wellness Program outcomes will be important from Senior Management point of view?

• It’s never too late to incorporate Company Wellness Program evaluation into Company Wellness Programs.
• If your Company Wellness 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 Company Wellness 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 Company Wellness Program components. Compare the components of your Company Wellness Program to those that have been proven effective elsewhere.

Think ahead: what unexpected challenges might come up as you implement your Company Wellness Program? How could you adapt and change the Company Wellness 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 Health and Wellness 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 Company Wellness 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. By way of 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 workers 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 facility when the Dairy Month ‘Milk Mustache’ contest results in increased sales during lunch.

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

• Simplify Company Wellness Program
• If part of your Company Wellness Program is not working, try making that part less complicated.
• By way of 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 Company Wellness Program doesn’t turn out exactly as you planned? Look for what did turn out. Often, the ‘unexpected outcomes’ produce positive results.
• By way of 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, Company Wellness Program materials were made into a fitness guide.

Take the time to plan Company Wellness Programs before they are implemented.

Effective 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 Company Wellness 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 Company Wellness 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 Company Wellness 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.
• Begin the activity- Be flexible. Be prepared for unexpected challenges.
• Market the activity - Keep your Company Wellness Program visible for Senior Management, line and medical personnel, Company Wellness Program participants, and potential partners and volunteers.
• Collect and analyze outcomes - Outcomes indicate Company Wellness Program impact. Begin with just a few outcomes – you don’t have to collect everything. Remember that it’s never too late to start measuring Company Wellness Program impact.
• Evaluate, improve and re-evaluate - Use participant feedback and Company Wellness Program outcomes to determine Company Wellness 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 participants immediate feedback on the changes they make towards better health. Measuring these small steps is also an excellent way to collect interim Company Wellness Program effectiveness information.

Company Wellness Program small steps make a big difference

Small steps for Company Wellness Program participants
• 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 Company Wellness 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 participants how their health behaviors are changing for the better.

• Ask participants 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 creative! 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 Company Wellness 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)

Why Company Wellness Program follow up?

Getting feedback from Company Wellness Program participants serves two purposes: to obtain information that quantifies a Wellness Program’s impact, and to find ways to improve a Company Wellness Program.

Building follow up into your Company Wellness Program

Make it Simple
• Keep follow up to information you absolutely require. A three-question survey is more likely to get a response than one with 20 questions.
• Use email or phone for follow-up. Use personal, AKO, and installation email addresses; use cell phone and unit phone numbers.
• Go to the Employees: go to the unit or somewhere else they will all be gathered (like the APFT test location), and get follow up information there.
• Give participants a stamped envelope addressed to you, with a printed form listing the information you will need.

Keep it structured
• Tell participants right from the beginning that you will be doing follow up after the Company Wellness Program is finished. Be specific about the information you will collect.
• If you need to do hands-on measurements, find out if participants will be coming back to your location for another reason (like another clinic appointment). Ask them to stop by while they are in the building – or, better yet, go to where they will be.
• Ask participants where they will be the next time you will be collecting information. They may already know their next duty station if they will be PCSing soon.
• Plan ahead for follow up and put it on the schedule. Planning to do follow up “when you have time” usually means follow up will never get done.

Keep it catchy
• Give participants something to go along with the request for information. By way of example, if you send an email to ask for information, send along a yummy recipe or a timely fitness tip.
• Schedule a ‘reunion’ day to collect follow up information. Invite participants to come back and share successes and challenges. Have some (healthy) munchies available.
• Have a silly contest – the team with the most follow up information wins something, like having their photos posted on a prominently-placed bulletin board or an eggplant trophy, or some other fun thing.