[Overview] An important strategy for addressing the health-

care crisis is to reduce the need for medical services by keeping people healthy.

Research shows that as health risks increase, costs increase; as health risks

decrease, cost decrease.1,2 Managers and HR professionals offer wellness programs to

lower these risks and achieve other benefits (see table below). Typically, these programs

include health behavior assessments, education, counseling, campaigns, and incentives —

initiatives that encourage employees to become physically active, eat healthier, stop smoking,

manage stress, or adopt some other wellness practice. Employees seem motivated: most (80+%)

attempt some form of lifestyle improvement annually.3

Unless we keep people from migrating toward new health risks,hoped-for benefits are unlikely to materialize.3 The greatest long-term

health-promoting and cost-saving opportunity is to keep low-riskindividuals from becoming higher risk.

[1]

The word [CULTURE](from the farming concept of

cultivation6) refers to the socialforces that shape behavior and

beliefs through mechanismssuch as norms, support,

modeling, training, rewards, andcommunication. Strong cultures

offer reliable, consistent guidanceabout attitudes and behavior;

weak cultures do not send clearsignals. Cultures work at both

conscious and unconsciouslevels, from concrete procedures

(like no smoking policies) tosubtle influences (like peer groupattitudes about exercising during

lunch). Workplace culture is akey to profitability, sustainability,

and other success measures.7

Making wellness work is well worth it…

BENEFIT EXPLANATION

Reduce Health Risks Half of all diseases and premature deaths areattributed to unhealthy lifestyle practices such assmoking, physical inactivity, unhealthy diets,and alcohol abuse.

Control Healthcare Costs Wellness plays a role in prevention, properself-care, disease management, and cost-effectiveuse of medical care.

Heal Most illness can best be remedied with treatmentsthat include healthier lifestyle practices, stressmanagement, and a positive attitude. Wellness isa part of healing.

Deliver Peak Performance Productivity and health are closely linked.

Provide Opportunities Helping others is among the best ways to enhanceto Assist self-esteem, deepen wellness commitments, and

reinforce lifestyle change.

Enhance Teamwork/Morale Wellness programs can open new communicationchannels, break down prejudices, and demonstratehow employees are valued. It’s one more goodreason for people to work together.

Improve Image Supporting employee and community wellness isa strategy for demonstrating good stewardship, apositive work environment, and corporate citizenship.

[End Notes]1 Edington, D, Emerging Research – A View From One ResearchCenter, American Journal of Health Promotion, 2001, volume15:5, pages 341-349.

2 Pronk, N, Goodman, M, O’Connor, P, Martinson, B, RelationshipBetween Modifiable Health Risks and Short-Term Health CareCharges, Journal of the American Medical Association, 282(23),pages 2235-2239.

3 Edington D, Yen L, Witting P, The Financial Impact of Changesin Personal Health Practices, Journal of Occupational andEnvironmental Medicine, 1997; 39: pages 1037-1046.

4 Allen, J, Building Supportive Cultural Environments, O’DonnellMP, editor, Health Promotion in the Workplace, Third Edition,Albany, New York: Delmar Publishers, Inc; 2001, pages202-217.

5 Linman, Laura, Weiner, B, Graham, A, Emmons, K, ManagerBeliefs Regarding Worksite Health Promotion: Findings From theWorking Healthy Project 2, American Journal of HealthPromotion, 2007, volume 21:6, pages 521-528.

6 Merriam-Webster Online Dictionary, Internet Springfield MA:Merriam-Webster, Inc. (cited Dec. 3, 2007);www.webster.com/dictionary/culture.

7 Schein, EH, The Corporate Culture Survival Guide, SanFrancisco: Jossey-Bass Publishers, 1999.

8 Allen R, Allen J, Certner B, Kraft C, The OrganizationalUnconscious: How to Create the Corporate Culture You Wantand Need, Second Edition, Burlington, Vermont: HumanResources Institute; 1987.

9 Allen, J, Not Alone: Healthy Habits, Helpful Friends,Healthyculture.com Publisher, Burlington, Vermont, 2007.

10 Allen, J, Wellness Mentoring Can Help Rebuild the CorporateCulture, AWHP’s Worksite Health, 1998; Summer: pages 27-30.

11 Allen, RF, Allen J, A Sense of Community, a Shared Vision,and a Positive Culture: Core Enabling Factors in Culture BasedHealth Promotion Efforts, American Journal of HealthPromotion. 1987; 1(3): pages 40 47.

12 Allen, J, Hunnicutt, D, Johnson, J, Fostering WellnessLeadership: A New Model, Special Report from the WellnessCouncils of America: Omaha, Nebraska, 1999.

This white paper was prepared for Health EnhancementSystems by Judd Robert Allen, PhD, President, HumanResources Institute, LLC. Contact: 802.862.8855,JuddA@healthyculture.com.

Additional copies of Achieving a Culture of Health: TheBusiness Case – as well as our white papers Keeping HealthyPeople Healthy: The Business Case and Employer-SponsoredWeight Management Programs: The Business Case – areavailable online at www.HealthEnhancementSystems.comor by calling 800.326.2317.

Wellness Committees –A Special Culture Change RoleWellness committees can play an important role in health culture planning

and follow-through. They should comprise influential people who are

passionate about wellness and represent a cross section of employees.

Committee members must be capable of:

n Seeing all the subcultures

n Keeping the culture change effort well organized

n Renewing the culture change vision periodically.

Outside wellness consultants should be availableto guide committee work, conduct objectiveresearch, and introduce best practices.

Creating a Wellness Culture Together Culture change offers methods for:

n Engaging the entire population

n Preventing new health risk behaviors

n Making it more likely that people will achieve healthy lifestyle goals.

The focus is on collective action — how people can work together to

achieve wellness. Individual strategies (such as health risk appraisals,

online information, wellness coaching, and incentive campaigns) can

be combined with culture strategies to achieve higher lifestyle change

success rates.

The approach that combines individual initiativewith ongoing support makes good business senseand is consistent with practices widely appreciatedamong business leaders and HR professionals.

[6]

P H A S E 4

SUSTAINABILITY

Evaluate Progress

Celebrate Success

Renew and Extend

[Systematic] Culture ChangeCulture change is a long-term process that is best achieved systematically.8

In most organizations, 4 phases — carried out over a year or more — make up a practical approach:

Health Culture LeadershipExecutives, managers, supervisors, peer leaders, wellness enthusiasts, and other stake-

holders must be empowered to support the wellness initiative for a health culture.12

Training, retreats,and clear communicationare important functions in mobilizingeffective health culture leaders.

Preparation is done primarily

through culture surveys, focus

interviews, observation, and

assignment of leaders

(see the next section).

Integration emphasizes peer

support initiatives and modifi-

cation of touch points when

new policies, procedures, and

programs are implemented.

Sustainability involves

measuring results, celebrating

success, and planning a new

round of culture change.

Involvement introduces

the wellness program vision

to employees and gives

them an opportunity to set

personal goals.

LEADERSHIP FUNCTION LEADERSHIP ACTIONS

Share the Vision Explain the purposes of the program, why they areenthusiastic about wellness, how employees canparticipate, and resources that will be available.

Serve as Role Models Participate in wellness activities, tell employeeshow wellness has benefited them personally,and share their own wellness goals.

Align Touch Points Address health culture influences (such as rewards,confrontation, and training), give permission to fullyuse program, and eliminate barriers.

Monitor and Celebrate Success Acknowledge individual and group progress(with permission).

P H A S E 1

PREPARATION

Analyze

Set Objectives

Develop Leaders

P H A S E 2

INVOLVEMENT

Introduce the Visionof the New Culture

to All Levels

P H A S E 3

INTEGRATION

Align CulturalTouch Points

Primary leadership responsibilities:

[5]

[2]

Unfortunately, less than 20% of

employee lifestyle change efforts reach

long-term goals.4 Employees tend to make

progress for a few weeks and months only

to return to their prior behavior. How do

employers meet this challenge?

Managers, HR, and wellness professionals

are well aware that little of lasting value,

including health improvements, can be

achieved without a supportive cultural

environment. In a recent manager survey5,

only 34% thought information alone would

be enough to promote healthy changes.

And just 41% agreed employers have a

responsibility to encourage employees'

healthy lifestyle choices.4 In some

organizations, health promotion may be

seen as an encroachment on individual

responsibility and privacy.

Fortunately, a health culture can

support positive changes without undermin-

ing individual initiative. Most smokers have

tried to quit. Almost all overweight people

have attempted diets. Most couch potatoes

have set goals for physical activity. The

objective is to create a workplace where

those new positive practices will stick.

Adults are most likely to change a health

behavior when supported by the people

they spend time with, backed by policies

and initiatives.

With that in mind, this white paper explores

understanding and changing workplace

culture to support employee health and pro-

ductivity, including:

n A framework to assess main elements

n Tools and techniques for change

n Various roles in creating healthy cultures.

A[Culture Change] FrameworkCultures are complex systems; they're best understood and evaluated by

adopting a framework – such as Normative Systems, the subject of more than

50 books and journal articles.8 It identifies 5 primary culture elements:

Norms

Touch Points

Work Climate Peer Support

SharedValues/Priorities BEHAVIOR

CHOICES

[Shared Values/Priorities]Most successful organizations’ cultures value profitability, customer service, and

innovation or some variation on those themes. In a health culture, employee

well-being also makes the top tier of priorities… embracing the idea that

healthy people are essential to overall strategy.

Each organization should examine its story and goals for a compelling wellness

vision. For example, at Johnson & Johnson the company's history and future

are seen as about finding ways to promote health; wellness is embedded in

how people think about their employer. In many businesses, personal growth of

founders can be communicated to highlight how people achieve their dreams

with the support of others. Pulling together to overcome challenges can

become a compelling wellness message.

Opinion surveys are useful in gauging

how highly health promotion is valued.

Employees express a range of

attitudes toward wellness — from

wildly enthusiastic to utterly scornful.

Don’t get preoccupied withnaysayers; let your health culturesoften up this group. Shifting each individual's positioncloser to wellness champion is the goal. Use the entirewellness value proposition. An employee need notchoose among the wellness benefits of containinghealth cost, raising performance, enhancing morale,or improving the company’s image. Wellness candeliver these benefits and much more.

[Norms]Norms are social expectations for behavior and beliefs — “the way we do things around

here” — which become apparent only when they change or someone violates them.

(Test this by driving 5 mph below the speed limit. That's likely to result in push-back from

other motorists. Though no law is broken, norms have their own enforcement mecha-

nisms, as we'll discuss under touch points below.)

A wellness culture features norms that make it easier for people to maintain healthy

lifestyles — for example, it could be a strong norm to drink water and eat nutritious

snacks low in fat, sugar, and salt. Freedom of choice still would be honored because

people could bring in their own junk food and soda without being ridiculed. In another

health culture example, the norm would be for employees to use their breaks for

physical activity, healthy eating, stress management, and friendship; the smoking

break would not be the only way to get a time out.

TOUCH POINT QUESTIONS TO CONSIDER

Modeling • Do leaders and other opinion makers model healthy behavior or something else? • Who could serve as new wellness role models? • How can the visibility of negative models be reduced?

Rewards • Are unhealthy practices mistakenly being rewarded or recognized? and Recognition • If someone behaved in healthy ways, would their behavior be acknowledged?

Confrontation • Are unhealthy practices mistakenly confronted? • Would there be push-back from the culture if someone behaved in a healthy way?

Recruitment • Do those seeking work know this is a health-oriented culture?and Selection • Are new recruits open to and enthusiastic about a wellness lifestyle?

Orientation • What is the early experience of employees related to healthy lifestyle choices?• Are new people informed about the wellness program vision and invited to become wellness champions?

Training • Are people taught the skills they need to be good at healthy lifestyle practices?• Are people mistakenly being taught how to get by with an unhealthy lifestyle?

Rites, Symbols, • Are there special events, daily/monthly activities, and symbolic reminders that wellness is important?and Rituals • Are unhealthy practices such as overeating featured in special events?

Communication • Are people given the information they need to make good decisions about wellness?• Are people given regular feedback about personal wellness and wellness within their workgroup?• Do unhealthy practices get all the attention?

Relationship • Are work friendships and teams formed during healthy activities?Development • Are work relationships formed around unhealthy practices such as overeating, complaining, and smoking?

Resource • Do people have the time, equipment, food, childcare, and other resources needed for a healthy lifestyle?Commitment • Does the use of time, money, and other resources demonstrate a commitment to supporting

healthy lifestyle choices?

[Touch Points]These touch points are the mechanisms for establishing and maintaining norms. They operate in formal policies, procedures, and

programs as well as informal, unwritten social mechanisms. Policies of sticking to a 40-hour work week and taking regular breaks,

for example, can be overpowered by praise for going “the extra mile.”

Establishing new wellness norms

(in general, 2-4 a year) is an important

function of a health culture — after

surveying to learn perceptions and

preferences. Sample priorities include:

n Not smoking

n Exercising daily

n Healthy eating

n Getting enough sleep

n Focusing on other health behaviors

based on organization specifics, such as

substance abuse or medical self-care.

[3]

Changing cultural norms and touch points

requires a deep understanding of the

current culture as well as a creative eye

for tweaking existing influences. Focus

groups with decision makers and a cross

section of employees can help identify

existing strengths and opportunities for

improvement. For example, workers could

share the best mechanism to implement

a new financial reward program so that it

isn’t perceived as a bribe or unfair.

These principles are useful in adjusting

touch points:

n Build on existing strengths by seeing

what’s positively influencing behavior

now (remember, touch points already

function in any culture; the key is to

adjust, not replace them — acknowl-

edging senior managers have the

most power to do this)

n Address enough touch points to tip the

balance toward wellness — using only

1 or 2 frequently backfires and rarely

achieves lasting results

n Consult those most affected by touch

point changes… often.

[Peer Support]In a wellness culture, peer support is

assistance from friends, family, cowork-

ers, and supervisors to achieve a healthy

lifestyle. Wellness programs often include

peer support initiatives in the form of

12-step programs, weight control groups,

sports teams, recreation events, yoga

classes, and running/walking/biking

competitions. These activities can be

open to employees’ families and friends

for even stronger support.

Although the support role is being

increasingly relegated to external profes-

sionals (therapists, wellness counselors,

coaches), an effective culture change

strategy is to enhance the quality and

quantity of informal, internal peer support

networks.9 For instance, the Wellness

Mentoring10 approach teaches employees

how to:

n Establish a mentoring relationship

n Set goals using the stages of change

n Locate effective role models and the

right wellness buddies

n Eliminate barriers to change

n Find or create supportive environments

n Work through relapse

n Celebrate success.

These methods offer numerous benefits

for a health culture; they:

n Have staying power

n Create natural allies and wellness

champions throughout the organization

n Reinforce self-change skills and raise

self-esteem

n Are a way to engage others in the

employee's support system.

[Work Climate]The 3 cultural climate factors described

below11 have been found to play important

roles in the intersection of organizational

development and individual wellness.

Where these factors are absent, employ-

ees may be so distracted by distrust,

anger, and negativity that they can't focus

on their own well-being:

Sense of Community. Wellness

programs can play an important role in

fostering a sense of belonging, trust,

caring, and mutual understanding in

the workplace.

Shared Vision. When everyone has

a role and a stake in achieving success,

the message is clear and inspirational.

Wellness programs can support this by

being responsive to new initiatives and

organization challenges.

Example: when a railroad must reduce

accidents related to fatigue and

substance abuse, the wellness program

can respond by bolstering healthier

norms for work-life balance, more

sleep, and less drinking.

Positive Outlook. Workplaces and

individuals thrive with optimism and

enthusiasm. Wellness programs can

encourage a positive outlook through a

focus on productive potential, thriving,

reaching health milestones, and overcom-

ing obstacles. The emphasis is on

strengths over weaknesses and investing

in productive people over seeing people

as risks or a cost of doing business.

[4]

How Health Enhancement SystemsProducts Support a Health CultureA leader in behavior change innovation, Health Enhancement Systems has been developing

health improvement solutions for corporations, health plans/systems, hospitals, government

agencies, educational institutions, nonprofits, and other groups since 1992. Our specialty is

programs that encourage participation in health improvement activities through engaging,

inspiring team and individual challenges.

Interactive, theme-based campaigns such as Get Fit on Route 66, 10K-A-Day, Colorful Choices,

Passport: Round Trip to Health, Great American Fitness Adventure, and NutriSum: Healthy

Weight for Life are keys to a health culture; they create a sense of community and dedication

to a common goal. Our approach is to have participants reach big goals in order to experience

big rewards. We believe behavior change not only requires a supportive environment, but also

serious commitment. Employers seeking a health culture will get there only through shared

responsibility between the organization and the individual. If you agree, we invite you

to review our offerings – visit www.HealthEnhancementSystems.com

or call 800.326.2317 (989.839.0852).

Copyright © 2008, Health Enhancement Systems. No part of this document may be distributed,reproduced, or posted without written permission from Health Enhancement Systems.

Health Enhancement Systems

110 E. Grove Street

Midland MI 48640

800.326.2317

www.HealthEnhancementSystems.com