Corporate Wellness Magazine August 2011

think one of the problems we are facing with the declining health of Americans is that we are trying to tackle the problem on too large of a basis; a macro level, when we should be focusing on a micro level. I think some insurance companies or employers think we can significantly change the way employees think, act

and behave, and so we try to implement large programs to encourage these monumental changes. The truth of the reality is that we need to think small, at first. We need to get individuals to want to change, and it doesn’t need to be a big step. Even a little step, can be like a ripple in a pond that has much larger implications, because once an individual takes that small step and wants to become healthy, a true transformation will happen. As an industry, we need to focus on where motivation lies at the core of the employees.

Our challenge is truly the fact of that matter that we are all busy in our daily work lives and caught up with family at home. In today’s culture, it can be overwhelming to fully engage in a healthy lifestyle. Between the constant distractions on TV, unhealthy food everywhere, and the fact walking has become an art form and we simply drive from place to place, it can be a true challenge to eat right and find time to exercise. Here’s a thought- Let’s stop focusing on saying that we want employees to “engage” in healthy behavior, and instead, focus on motivating employees to want to engage in one simple, healthy behavior. If employees set an attainable goal, one that makes them feel better about themselves when they take action, they will strive to achieve even more. Once we can accomplish this, only then can we get employees to engage in an overall healthier lifestyle.

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Copyright © 2011Corporate Wellness Magazine. All rights reserved. Corporate Wellness Magazine is published monthly by Global Health Insurance Publications. Material in this publication may not be reproduced in any way without express permission from Corporate Wellness Magazine. Requests for permission may be directed to [email protected]. Corporate Wellness Magazine is in no way responsible for the content of our advertisers or authors.

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Jonathan Edelheit

IJonathan Edelheit

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EDITOR’S LETTER

Tiny Steps, The Ripple Effect

FOLLOW US ON:

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YOUR EMPLOYEES WILL BE GLOBAL HEALTHCARE CONSUMERS ARE YOUPREPARED TO COMMUNICATE WITH THEM?

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5 STEPS TO BETTER DIABETES SELF-MANAGEMENT

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PROCRASTINATION, A MORDERN-DAY PLAGUE

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THE AMERICAN OSTEOPATHIC ASSOCIATION URGES AMERICANS TO BREAK THROUGH THEIR PAIN

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ENGAGING THE MIND BODY AND SPIRIT IN A WORKPLACE WELLNESS

INNOVATIVE SMOKING CESSATION PROGRAMSDRIVE SOLID RESULTS

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JULY 2011 EMPLOYER HEALTHCARE AND BENEFITS SURVEY RELEASED

INCREASING CHRONIC DISEASE COSTS LOWERED WITH DIGITAL HEALTH COACHING

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IS MODERATE EXERCISEENOUGH TO HELP PREVENT DISEASE?

WELLNESS MENTORING IS YOUR COMPANIES COMPETITIVE ADVANTAGE

By Shawn Connors

FEATURE

CorporateWellnessMagazine.com | August 2011 6

“perfect storm” of trends occurred about 10 years ago in the music industry, and it changed the

landscape of that business forever. A fresh wave of consumers suddenly had a new host of Internet tools and a profound sense of empowerment. The conventional method of buying music would soon be history.

Get ready, because a similar storm is brewing in the healthcare industry, and an important disruption is about to occur to the conventional system of wellness communication.

Important Trends Are at Work

These powerful fronts are colliding:

• Fast, self-help access to healthcare sources and data. Healthcare consumers arm themselves with information by simply using their fingertips. Credible Internet sources abound, and today’s patients can quickly scan reports, share links, ask questions and post comments.

• Rising healthcare costs, coupled with anxiety about money issues. Apprehension and hypertension persist. The recession might be over, but widespread worry about medical (and other) expenses remains. Many employees are largely covered under their current insurance plans for a variety of medical issues, and some folks also

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feel confident that they have funds in reserve, but now more than ever, they occupy a global buyer’s market. Healthcare consumers, like savvy retail shoppers, are price-conscious and determined to locate maximum overall value.

• Confusion about the future of the U.S. healthcare industry. Are your employees confident that they’ll qualify for a heart surgery or another major procedure in a few years? The more confusing the U.S. healthcare system gets — and the more bickering that persists over upcoming laws and regulations — the more consumers will seek alternative options for care. In general, we don’t like waiting around, especially in order to be told what to do.

Patients Are Realizing Their Power

The combination of these powerful trends will generate at least one important outcome: More of your employees are going to become global patients.

“Medical tourism,” the practice of traveling to receive medical, dental or surgical care, isn’t new, but it’s changing. U.S. residents have long been traveling to other countries for care, particularly for cosmetic surgery, dental work, procedures not covered by insurance and procedures not yet approved by the U.S. Food and Drug Administration (FDA). Today, however, many “medical tourists” are fully insured employees seeking all kinds of care—cardiology procedures, orthopedic surgery, spinal fusions, cancer treatments, bariatric surgery, fertility treatments, eye surgery and many more.

The biggest attraction for medical tourists is no secret — cost savings that are often huge. A heart-valve replacement priced at $200,000 or more in an American hospital can cost $10,000 in India, according to the University of Delaware, and that price includes airfare and a post-operative vacation package. Medical tourists receiving care

in Thailand save about 70 percent on average, and ones traveling to Latin America typically save at least 50 percent, according to the Medical Tourism Association.

The simple truth: Individuals will choose to travel for care when the care is of higher quality, more affordable and/or or more easily available than what they can receive at home.

“Many people believe markets perform better than governments in allocating resources, and are much faster to respond to the demands of consumers,” says Fred Hansen, a physician and journalist. “Patients are realizing that the power of the consumer vote, exercised many times every day on choices in different markets. The Internet and cheap airfares have greatly increased consumers’ opportunities and choices by creating new consumer-driven markets.”

In hopes of securing a piece of that market, several countries — especially India, Singapore and Thailand — offer state-of-the-art facilities that specifically cater to medical tourists. These facilities have advanced technologies and equipment, and often employ physicians trained and board-certified in the United States.

Employers and Benefit Firms Are Responding

More employers and employees are giving medical tourism options serious consideration. A June 2010 survey conducted by the Medical Tourism Association at a Society for Human Resource Management (SHRM) conference found that 48 percent of the employers surveyed are “interested” in offering medical tourism to their employers on a voluntary basis, with 36 percent indicating they “might be interested.”

Experts say the medical tourism industry could turn a corner if enough U.S. employers and insurers


actively promote and underwrite it. Medical tourism is now being considered by industry giants like CIGNA, Aetna and BlueCross BlueShield, all of whom say they have either started or will soon start pilot programs that will offer partial travel medical insurance.

Other insurers have already launched pilot programs:

• Wellpoint began offering a pilot program with Serigraph Inc., a Wisconsin-based printing company. Under the program, members of Serigraph’s health plan can elect to travel to India to undergo certain procedures, including major joint replacement and upper and lower back fusion, and pay lower out-of-pocket costs.

• IDMI Systems Inc., a Georgia-based automation software developer, contracted with Companion Global Healthcare to provide medical tourism options for certain medical procedures to employees and dependents covered by the company’s self-funded health plan.

Disruptions Are Coming

We believe more companies will realize the credibility and viability of medical tourism, and will begin offering options for employees. Also, companies with self-funded plans will begin incentivizing employees to travel abroad for care.

The coming rise in medical tourism will be disruptive to the conventional healthcare system in profound ways:

• It will reduce the power of coalitions’ purchasing power when they approach healthcare providers.

• It will lead to new “centers of excellence” located across the world. Latin America is already becoming one for dental work, and India is becoming one for heart surgery.

• It will showcase the fact that employers aren’t

going to give up their rights to affordable healthcare in an open, global economy.

Are You Preparing?

Are medical tourism options right for your employees? You need to take into consideration several different factors, including current health plan choices, employee demographics, risk associated with receiving care abroad and the medical tourism benefit options offered by insurers.

No matter what you think of medical tourism, it’s wise to prepare your communication. If you choose to help employees seek overseas care, what messages and education materials can you offer so they can gain a clearer understanding of medical tourism’s advantages? Providing and promoting these materials will help them decide whether medical tourism is right for them.

If you choose to not help employees seek overseas care, how will you communicate that decision and defend your reasoning?

Here are the two most common questions employees have about medical tourism, and perspective you can share:

• Why don’t more insurers offer medical tourism options? Insurers want to take reasonable measures that providers overseas have the credentials to provide adequate care. They’re also concerned with continuity of care — for example, how much are they willing to cover for physical therapy back in the U.S.?

• Do treatments take place in low-quality facilities? Not usually. Medical tourists can find facilities abroad that are as good as ones in the U.S. About 220 overseas hospitals are certified by Joint Commission International, and most doctors who treat medical tourists have trained in the United


States, Australia, Canada or Europe.

In addition to answering employees’ questions, here is news to keep in mind when considering (or implementing) a medical tourism benefit option:

• New medical tourism guidelines have been created. U.S. organizations have begun to establish medical tourism guidelines and programs to assist people in choosing appropriate health care for their needs. Employers should ensure employees have a wide range of materials available to them to help them decide which route to care is appropriate. These resources include new medical tourism guidelines from the American Medical Association that the organizations says employers, insurance companies and other entities that facilitate or incentivize medical tourism should adhere to. The guidelines suggest that patients should be referred only to facilities that have been accredited by recognized international accrediting bodies, such as the Joint Commission International or the International Society for Quality in Health Care.

• The Medical Tourism Association recently launched its Quality of Care Project. The project

focuses on enhancing transparency of the quality of care worldwide so that employers, patients and insurers can better assess and compare facilities around the world. The project aims to create a single methodology for reporting certain statistics and quality indicators, so that individuals and companies can compare health care facilities’ quality, costs, patient volumes and patient safety records.

BioShawn M. Connors is president of Hope Health. He believes behavior change requires a mix of both art and science. He founded the International Health Awareness Center, Inc. (IHAC) in 1981, which focuses on the importance of communication in positively affecting workplace cultures. Recently, he worked with a talented team to develop a workable, realistic health communication system, empowering thousands of workplaces and community-based clients to communicate more effectively with new media. Shawn has earned the respect of marketing professionals and health educators alike.


5 Steps

to Better Diabetes Self-Management

hen you have diabetes, much of your treatment and care comes from the decisions you make on a daily basis. Navigating through these daily decisions can sometimes be challenging if you don’t know where to start. Use these “5 Steps to Better Diabetes Self-Management” as a road

map to begin your journey toward well-controlled diabetes.W

By Carina Saez

• Monitor your glucose.

• Take your medications!

• Be mindful of your food choices.

• Get up and get moving!

• Keep your doctor’s appointments.

Step 1: Monitor your glucose.

Part of having diabetes is knowing how to monitor your glucose. It is an essential key to good blood sugar control, because it is the only way to know (between doctor’s appointments) where you stand with your diabetes control. “Do I have to?” or “Ouch that hurts!” are common sentiments I hear from patients. My answer is usually YES, and it’s not that bad! Fortunately, glucometers (blood sugar machine) have come a long way. They require a very small amount of blood (about the size of pin head) and the needles are fine and hurt less when changed often. Also, many offer the option of checking your hand or arm versus the

Worksite Wellness


fingertip. The frequency should be discussed with your physician but in general at least one to two times per day is recommended. According to the American Diabetes Association (ADA) and the American College of Endocrinology (ACE), the recommendation for a Fasting Blood Sugar (when you just woke up BEFORE your morning coffee) is less than 110 mg/dl. The guidelines for post-meal glucose differ slightly. The ADA states a post-meal goal of less than 180mg/dl. This is for immediately following a meal at its peak. The ACE guidelines state the goal two hours after a meal should be less than 140 mg/dl. Remember: checking your blood sugar keeps you in control of your diabetes.

Step 2: Take your medications!

This may seem like simple advice, but it is a key step that is often overlooked by diabetics. “Now that my sugars are controlled I don’t need to take my pills anymore” or “Once I start taking medications I can never stop” are phrases I hear often when counseling someone with diabetes. The truth is that medications really do serve a purpose in glucose control. There are several different types of medications to take for diabetes, and they work on different parts of the body. One type of medication works on the pancreas by stimulating it to excrete more insulin. Insulin is a hormone that helps lower blood glucose by helping it enter the blood cells to be converted into energy. Another type of medication works on fat and muscle cells to make them sensitive to the body’s own insulin. Often in Type 2 diabetics, the body becomes resistant to using the insulin, even though it may still be produced. Yet another type of medication works on the liver by controlling the amount of sugar that the liver makes. One of the newer medications is injectable and works on all 3 areas (pancreas, cells and liver) and has the added benefit of slowing down the digestion of food which promotes weight loss. Type 2 diabetes is a progressive disease, and often pills fail to work because the body no longer produces a sufficient amount of insulin. At this point insulin by injection becomes necessary. Taking insulin can give you greater flexibility for your glucose management. You can work with your doctor or diabetes educator to learn how to adjust your insulin. Taking insulin can be the key to lowering your blood sugar average and may help prevent the chronic complications associated with diabetes like kidney or eye disease.

Step 3: Be mindful of your food choices.

A key part of managing your diabetes is eating healthy foods every day. You want to know which foods to increase and which foods to limit. The “diabetic diet” can seem ominous and confusing. There are many messages that can confuse any diabetic: Don’t eat sugar, count your carbohydrates, watch out for high glycemic index foods, eat good fat but limit bad fat, and eat more fiber! Learning about how different foods affect your blood sugar is important and can be done by scheduling a visit with a Registered Dietitian who can help you plan your meals to meet your health goals. When discussing the effects of carbohydrates, protein and



fat on blood sugar, carbohydrate portion control will help control blood glucose. One hundred percent of the carbohydrates you eat turn into sugar within a few hours of eating. Carbohydrates are any starch, fruit, milk, yogurt or sweet that you eat. Fortunately you don’t have to avoid these foods, but be aware of your portions. Some “carbs” (such as candy, cookies, ice cream, sodas and juices) turn into sugar faster. The goal is to eat high-fiber carbohydrates because they are absorbed into the blood stream at a slower rate. For example, eat fruits with skins and seeds, (apples, strawberries, etc.), choose whole grains like whole wheat bread and wild rice, and stick with fat free yogurt or skim milk. Remember to choose wisely and control the amount of carbohydrates you eat to notice the positive effect on your blood sugars.

Step 4: Get up and get moving!

The purpose of glucose (or blood sugar) in the blood stream is to provide energy. Since exercise requires energy, it helps you “use up” your blood sugar. Not only will exercise lower your blood sugar, it can also lower your blood pressure, improve circulation, decrease stress, improve sleep and aid in digestion. It is recommended that you add 150 minutes of exercise per week to promote and maintain a healthy weight. This equates to 30 minutes 5 times per week. There is no rule stating this 30 minutes must be done consecutively. If you only have time for 15 minutes in the morning and 15 at lunch time, do it! The most important part is to get up and get moving. One precaution to take when you have diabetes is to check your blood sugar before you exercise. If it is less than 100 mg/dl, then eat a snack containing carbohydrates (like crackers or fruit) prior to exercise. This will help to prevent hypoglycemia (low blood sugar). Hypoglycemia is defined as a blood sugar less than 70 mg/dl. If your blood sugar gets too low during exercise you should drink 4 oz of juice, sports drink or soda to raise it quickly and stop exercising until you feel better. Once your sugar is above 70 mg/dl make sure to have a snack that has protein (like cheese , nuts or peanut butter). The protein stays in your blood stream longer and can help prevent a rebound low blood sugar once you resume your exercise. Once you become consistent with your exercise, your blood sugar be better controlled, and you will also feel better and more energized!

Step 5: Keep your doctor’s appointments.

You know the old saying,“An apple a day keeps the doctor away?” But, with diabetes it’s “See your physician today and keep complications away!” This might sound cheesy, but it will help you remember why you need to see your doctor on a regular basis. Depending on your glucose control, you may need to see your physician every six months or even every three months (maybe even monthly). That will be up to you and

your physician. It is recommended that diabetics get the following exams yearly: Eye Exam, Foot Exam, Kidney Function Blood Test, Urinalysis, Cholesterol (including Total Cholesterol, HDL Cholesterol and Triglycerides) and a Flu Shot. In addition, your physician will monitor your “A1C” test two to four times per year. The A1C test measures blood glucose over a two to three month period. ADA recommends an A1C under 7 percent,which is an estimated average under 150 mg/dl. Higher A1C levels have been associated with increased risk for chronic complications like eye disease, heart disease, kidney damage and nerve damage which can lead to amputations. At your physician appointment, you should take your blood sugar journal, so the physician can compare your A1C to your actual daily blood sugars. He/she will use this to adjust your medications and help you with your health goals. This is also your time to ask questions. If you are unsure about how a medication works or why a treatment your doctor has recommended is important, this is the time to educate yourself. Your physician may also refer you to a specialist, if needed. I always encourage patients to see the doctor and remind them that they are there to help you manage your Diabetes.

Keep these 5 steps in mind as you make your health goals for optimal diabetes control. You may not do all of them every day, but they are there to help you remember what is important. Identify the area(s) that may need improvement and set one goal. Write your goal down and share it with someone who can be your support to help you reach it. Using these steps may be as simple as checking your blood sugar in the morning before your healthy breakfast of ½ cup oatmeal strawberries and almonds, going on a 15 min walk at lunch, calling your physician to confirm your three month appointment and checking your pill box each night to make sure you took your medication!

BioCarina Saez is a Registered and Licensed Dietitian as well as a Certified Diabetes Educator specializing in diabetes education and weight management. She is a graduate of Texas Christian University and has been counseling patients for the past 16 years. Carina evaluates and counsels patients in diabetes management, cholesterol and hypertension control. She is currently the Diabetes Care Manager at Viverae. Viverae helps corporations reduce health care costs through improved employee health.


Is Moderate Exercise Enough to Help Prevent Disease?

Can regular physical activity really help prevent certain types of disease?

Yes! In addition to many other health benefits of exercise, researchers are learning that physical activity can also affect the risk of disease—cancer included. There is good evidence that physical activity has been show to reduce cancers of the colon and breast. Several studies also found relationships between increased levels of physical activity and a reduced risk of cancers of the prostate, lung, and lining of the uterus.

I don’t havemuch time to exercise, what can I do during the day that doesn’t take a lot of time?

I always suggest something like what we do at my own workplace. We encourage very small breaks (which can add up!). Maybe it is a ten minute walk around your workplace, a few times a day when you have breaks. You could also take small weights and hold them while climbing a few flights of stairs. The key is to start gradually. Also, people need to be prepared to exercise when they have time. So, this means having a pair of

exercise shoes ready and available at work or at home to encourage you to get moving. Pedometers and good music are also terrific motivators.

Are there any new findings in regard to exercise and its benefits, in addition to disease prevention?

One key finding is that bouts of physical activity in 10-minute segments can help individuals achieve health

By Rachel Permuth-Levine & Leslee McGovern

INTERVIEW


benefits. The recent physical activity guidelines issued by the Department of Health and Human Services are the most substantial piece of guidance that we can give Americans about different forms of physical activity. For instance, for adults aged 18-64, the guidelines are as follows (REFERENCE: http://www.health.gov/paguidelines/factsheetprof.aspx)

• Adults should do 2 hours and 30 minutes a week of moderate-intensity, or 1 hour and 15 minutes (75 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. Aerobic activity should be performed in episodes of at least 10 minutes, preferably spread throughout the week.

• Additional health benefits are provided by increasing to 5 hours (300 minutes) a week of moderate-intensity aerobic physical activity, or 2 hours and 30 minutes a week of vigorous-intensity physical activity, or an equivalent combination of both.

• Adults should also do muscle-strengthening activities that involve all major muscle groups performed on 2 or more days per week.

Are there any unexpected benefits to exercising moderately?

Yes. A team of researchers from the Translational Research Branch Translational Medicine Branch of NHLBI hypothesized that a sedentary work force is at increased risk for future cardiovascular disease. They looked at the effects of staff engaging in a 15-minute-per-day exercise program at these work-site exercise facilities at NIH on the endothelium, the thin layer of cells that line blood vessels that is a biomarker of risk. They found that even in the absence of weight loss, relatively brief periods of exercise daily during the workday improved endothelial function.



Is moderate exercise on a regular basis enough to boost one’s health in relation to cancer?

We think so. There are numerous studies that test for potential benefits of moderate exercise, some study relatively healthy individuals and others explore different populations who are trying to regain their health. For instance, in a study at Southern Illinois University, their intervention among women breast cancer survivors found that there were sustained improvements in physical activity, strength, central adiposity, and social well-being with lower extremity function benefits appearing 3 months after intervention completion. At Harvard Medical School, researchers found that with patients with stable heart failure, exercise training can relieve symptoms, improve exercise capacity and quality of life, as well as reduce hospitalization and, to some extent, risk of mortality. Thus, if we can see benefits of moderate exercise in people who are recovering from disease, we might see even greater possibility in those of us who are mostly well.

What is the main reason your patients (employees/clients) cite for not exercising on a regular basis?

Time is the biggest barrier for people. They always tell me they just don’t have enough time during the day to workout. We try to remind people that they don’t need huge chunks of time to maintain a good level of health. 10 minutes at a time, even for a simple walk, can really add up. If people can set realistic goals for taking mini-exercise breaks throughout the day, they would likely see

a change in their mood and energy levels.

Is there something I should have asked you that I didn’t, or something related that you would like to make a comment about?

We always encourage people to start small and to set realistic goals. Achieving better health starts slowly, particularly if we are not already in the habit of exercising. If people who have not exercised before start with small increments of walking or taking the stairs, these are habits that are much more likely to be incorporated into one’s lifestyle, rather than larger exercise sessions that might fade away if our lives become too busy.

RESOURCES: Centers for Disease Control and Prevention (2008). Preventing Obesity and Chronic Diseases Through Good Nutrition and Physical Activity. Retrieved June 26, 2009, from: http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm.

Bio Rachel Permuth-Levine, PhD, MSPHan expert in workplace solutions and organizational development for Sodexo. As a health behavior theorist, she strives to use evidence-based programs that produce the best results for her employees. Read more about a comprehensive approach to employee engagement and exemplary workplaces at www.tolive.com

Leslee has more than 20 years experience in food and wellness marketing and communications. She is a registered and licensed dietitian with a master’s degree in nutrition communications from Boston University. She is a member of the American Dietetic Association and its practice groups, Dietitians in Business and Communication, and Sports, Cardiovascular and Wellness Nutritionists.

hether your work day is spent behind a desk or on the move, pain is something

we have all experienced at one point or another. In fact, a recent survey from the American Osteopathic Association (AOA) found that more than 70 percent of Americans say they, or someone they care for, have experienced pain over the last month. Nationally, more than 76 million people live with pain every day — that’s more people than have cancer, diabetes and heart disease combined.

Pain that does not go away after an injury has healed or affects your life for more than three months, called chronic pain, is a serious and unaddressed public health issue that can disrupt our lives at work and home. Chronic pain can come in many different forms, affect many parts of the body and interfere with your mood, sleep, attitude, social life and work productivity. In fact, the American

Academy of Pain Medicine estimates that the American workforce loses $61.2 billion in productive time to chronic pain on average each year.

Whether your pain is affecting your personal life or making you less productive at work, the most important question to ask yourself is: Do I have to live with the pain? With the AOA survey revealing that nearly half of Americans mistakenly believe pain is just part of life or part of the aging process, there is a clear need to dispel the common misperceptions associated with pain.

By raising awareness about the safe and effective treatment options available to help those living with pain, the AOA, which represents the nation’s more than 78,000 osteopathic physicians (DOs), is working to dispel the most common myths associated with pain and empower Americans to take action and get the help they need.

WBy Dr. Giaimo



Pain: Separating Fact from Fiction

I’ll Just Live with the Pain

Too many people suffer from pain in silence believing it is just part of their daily life. In fact, two in five (41 percent) Americans said they would not visit a medical professional for their chronic pain. In order to find relief, it’s important to speak with your physician about what you are experiencing right away. Ignoring or undertreating pain can actually lead to more pain, creating a debilitating cycle. Once you start an open discussion with your physician, you can work together to develop a treatment plan that will help you get back to living a more active life with less pain.

My Pain Only Affects Me

Chronic pain is a significant public health issue. While the negative impact of living with pain starts with the individual, it also affects your work team and the entire family unit. At work, pain may make it difficult to concentrate on the task at hand, which can negatively affect quality of work and disrupt team productivity. At home, when pain keeps parents from picking up small children or fully participating in daily family life, everyone feels the impact. When seeking treatment for pain, it’s important to engage members of your family and even bring them with you to help describe how your pain is impacting daily life at home. With open communication, you can work together with your physician to develop a treatment plan that takes the whole family into account.

My Pain Can’t Be Treated Anyway

While nearly half (48 percent) of Americans don’t believe pain is something that can be eased with proper treatment, it’s important to realize that there is no “one size fits all” treatment for pain. Just as chronic pain comes in many forms and affects many different parts of the body, there are a wide range of treatment options available, ranging from exercise or physical therapy to hands-on treatments or rest. It’s important to take an integrated approach to treating pain. Pain medication

may only be one part of the overall treatment approach you develop with your physician.

Effective treatment requires an individualized pain management program that can only be developed through open patient and physician collaboration. To help you get started, the AOA offers a variety of patient tools available to help you begin an open dialogue to discuss your pain with your physician.

Take Action to Overcome Your Pain

Rather than viewing pain as a sign of weakness,the AOA encourages those living with pain to find ways to describe how they are feeling and engage in an open discussion with their physician. Now is the time to take charge of your health and make a positive change that can improve your life at work and at home.

The AOA aims to empower all Americans living with pain to break through it, starting with a few simple steps:

1. Visit the AOA website and take advantage of new pain assessment tools that can help you describe and track your pain. The Living With Pain? Quiz and Break Through The Pain! Assessment Tool/Patient Journal are both available at www.osteopathic.org/pain.

2. Make an appointment to speak with your physician about your pain – ignoring or under-treating your pain can lead to more pain – creating a debilitating cycle.

3. Work with your physician to design an individualized treatment plan that meets your needs. Managing chronic pain is not a “one size fits all” diagnosis. Just as there are multiple types of chronic pain, there are a wide variety of treatment options, ranging from medication to hands-on treatment.

4. Follow your personalized pain management/treatment plan – sticking to a treatment plan will pay off in the long-run.

BioDr. Giaimo, A fellow of the American College of Osteopathic Internists and the American College of Chest Physicians, Joseph A. Giaimo, DO, is an AOA board-certified internist and pulmonologist in private practice in Palm Beach Gardens, Fla. He also serves as clinical assistant professor at the Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Fla.


ver since the first Surgeon General’s report was released nearly 50 years ago, the medical

and financial consequences of tobacco use have become widely known. Yet, despite the fact that more than one-half of U.S. states now ban smoking in workplaces, restaurants and bars, one in five adults continue to smoke regularly. Indeed, more than 360 billion cigarettes are smoked in the U.S. every year.

This persistence of tobacco use obliges employers to understand how smoking affects the well-being and productivity of their workforce, and to take action. With rising health care costs high on the CEO agenda, executives should firmly embrace innovative smoking cessation programs which can help their employees who smoke to quit the habit.

Grim Data

The statistics are grim. According to the 2010 U.S. Surgeon General report, cigarettes are responsible for approximately 443,000 deaths – 1 in every 5 deaths – each year in the U.S. The economic toll is also high. More than $193 billion annually in health care costs and productivity losses is attributable to cigarette use. Smokers are

also far more likely to suffer from chronic diseases, such as atherosclerosis — the buildup of fatty substances in the arteries - than are nonsmokers. In short, tobacco use is the largest cause of preventable illness and death.

Smokers miss an average of 6.16 days of work each year due to sickness, compared with 3.86 days for non-smokers. Not surprisingly, smokers visit health care facilities far more often than non-smoking employees, have more hospital admissions, and stay in the hospital for longer periods on average. Of course, the harmful effects of smoking also impinge on others. Thousands of nonsmokers are adversely affected and may die from heart disease and lung diseases, including lung cancer every year because of exposure to secondhand smoke.

New Urgency

The need for employers to address tobacco

use has taken on new urgency recently. According to the Surgeon General’s report, the way that tobacco is grown, mixed and processed today has caused cigarettes to become more addictive than ever before – making it even tougher for smokers to quit.

E

By Beena Thomas


Because chronic tobacco use in an intensely ingrained behavior, repeated interventions are often required for cessation efforts to be successful. But effective remedies exist. The Centers for Disease Control (CDC) declares tobacco cessation treatment as the “single most cost-effective health insurance benefit (for employees)”.

A study of 1,450 adults conducted in 2010 by OptumHealth and GfK Roper Public Affairs and Corporate Communications on smoking cessation found:• Virtually all successful former smokers had previously tried to stop smoking an average of 5.4 times before succeeding• 57 percent of successful former smokers had taken advantage of a smoking cessation program offered by their employer• 60 percent of those who quit reported that the workplace program was very helpful

Key Motivators for Change

The good news for employers is that motivation

is not lacking. Among current U.S. adult smokers, 70 percent report that they want to quit completely, according to the CDC.

The OptumHealth / GfK Roper study sought to understand the triggers that lead to successful behavioral change for smoking and weight loss, and how employers could design wellness programs that respond to those triggers. Seven out of ten respondents said that living a healthy lifestyle is important to them and believe that their health is mainly determined by their lifestyle choices, not solely by heredity. Clearly, they understand that health is related to behavior. Well over one-half of respondents cited the fear of future health problems as a key driver for changing their behavior.

Making a commitment to change was a key factor

cited by respondents who smoked. For this group, the secrets for successful quitting included: • Persistence: Most tried several times to quit before succeeding• Motivation: Nearly 70 percent said they wanted to improve their health, 65 percent wanted to feel better, and 62 percent wanted to live longer

Other strong motivators among the respondents included the desire to see their children grow up, and the determination to prove that they could quit smoking. Employers should not underestimate the power of these drivers. Their communications with smokers should address that competitive urge and leverage the emotional force of that challenge. Smoking cessation messaging must be inspirational, playing on employees’ desire to be healthy and active and to live a long life.

Personal Touch is Key

Through its research and client experience,

OptumHealth has found that robust tobacco cessation programs – those with frequent and intense contacts with wellness coaches - achieve higher quit rates than conventional approaches. These innovative programs are customized to each participant’s unique needs and readiness to change. They offer a high level of interaction with a wellness coach throughout the duration of the program, combined with nicotine replacement therapy (gum or patch) to optimize success rates.

The key to a successful cessation program is having a single coach who is dedicated to an employee and with whom close contact is maintained. That intimacy helps build trust and drive results. The coach identifies opportunities for reducing the number of cigarettes smoked and establishes short- and long-term goals against which the smoker is held accountable.

These programs are designed to change behavior


and pay dividends on the back end. It starts with multi-method risk identification that uses five separate data streams: online health assessments, on-site biometric screenings, medical insurance claims analysis, employee self-identification and program referrals to identify counseling candidates. Another key component is to stimulate motivation through ongoing communications so that employees will join the program once they are ready. Additional features include detailed monitoring and reporting with specific behavior and lifestyle change metrics.

Paying Dividends

OptumHealth recently conducted an extensiveevaluation of 9,271 employees who enrolled in its most intensive smoking cessation program (which includes multiple methods of identifying candidates, personalized coaching, nicotine therapy and ongoing monitoring).

The results were impressive: Nearly 39 percent reported not smoking as of their last call with their coach, and 65 percent of those who completed the program quit smoking. Additionally, the percentage of participants successfully quitting or reducing smoking increased as the number of coaching calls increased.

These programs can also be a smart investment. The combined savings in health care, productivity, workers compensation and disability costs from the

program is projected to deliver a targeted return on investment of 1:1 in year one, 2.5:1 in year two, and 4.5:1 in the third year of the program.

While intensive programs like these are designed to work in any corporate culture, they may be best suited for organizations with a high number of smokers – many of whom are willing to make a change, but require more intensive coaching sessions than traditional tobacco cessation programs to help them kick the habit.

Without question, quitting smoking is difficult and relapses are frequent. But employers can address this challenge with a vigorous tobacco cessation program that is anchored by frequent, intensive coaching.

Bio

Beena Thomas, director of wellness products for OptumHealth

Sources:1.http://www.surgeongeneral.gov/library/tobaccosmoke/report executivesummary.pdf2.http://www.surgeongeneral.gov/library/tobaccosmoke/report/executivesummary.pdf3.http://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/index.htm.


The Voluntary Benefits Magazine, Corporate Wellness Magazine, Self Funding Magazine, and Healthcare Reform Magazine, in partnership with the Employer Healthcare Congress, traveled in June to one of the largest employer conferences in the country and conducted a survey of hundreds of top HR professionals

nationwide. The Survey touched upon Voluntary Benefits, Corporate Wellness, Self Funding, and Healthcare Reform.

Of the employers participating in the survey 46% had up to 1,000 lives, 35% had between 1,000 to 10,000 lives, and 19% had over 10,000 lives. The Survey Results Found that:

Corporate Wellness

57% of respondents currently offer a Wellness Program, while 43% do not.

Voluntary Benefits

81% currently offer Voluntary Benefits to their employees, while 19% do not.

Self Funding

62% of respondents stated they self fund their medical plan, while 38% said they do not.

July 2011 Employer Healthcare Benefits Survey Released


July 2011 Employer Healthcare Benefits Survey Released


Healthcare Reform – Will it Increase Costs?

• An overall 76% felt healthcare costs would increase under healthcare reform; 57% of respondents felt that Healthcare Reform will significantly increase health insurance costs, while 11% felt it would lower healthcare costs. 19% felt it would just “increase” healthcare costs, but not significantly and 13% felt healthcare costs would remain the same.

Healthcare Reform – Will it be Positive or Negative for Business?

• 57% of respondents felt Healthcare Reform negatively affects their business while 43% believe it positively affects their business.

Healthcare Reform – Fine/Penalty for not buying insurance in 2014

65% of respondents felt that the $95 a year penalty for individuals who don’t buy health insurance in 2014 (increasing to $695 in 2016), is a large enough incentive to force people to buy health insurance. 35% of respondents felt it was not a large enough incentive to force people to buy health insurance.

Healthcare Reform – Destroying the Underwriting Process by Allowing Guarantee Issue and No Pre-ex in 2014

76% of respondents felt that starting in 2014, allowing any person to wait until they are sick to purchase health insurance and have immediate guaranteed coverage at the same price as a healthy person, would destroy the underwriting process, while 24% felt it would not.

Online Healthcare Information

78% of respondents felt that internet news, resource websites and social media are one of the most important sources for gathering information on healthcare issues, while 22% disagreed.

14

Corporate Wellness Magazine

w w w. C o r p o r at e We l l n e s s Ma g a z i n e . c o m

here is an old Chinese proverb that states, “No matter how far you’ve walked down the wrong road, stop!” It is time for companies to stop

squandering away their competitive resources and true business advantage. It is happening right under their eyes and in most cases they are unaware of it. Harsh words but as a business consultant for over twenty years I have witnessed the waste of intellectual talent in both the public and private sectors. Wellness experts must

also recognize this dilemma.

Today, building a competitive organization that regularly produces maximum results requires two main elements; employees with their collective experiences that make up an organization and the employees’ untapped or dormant skills.

TBy Wayne Weiner

Worksite Wellness


Successful organizations are collaborative, focused and adaptable.

So what does wellness mentoring have to do with all this? It has been my experience that each company I have worked with has not analyzed their work force in three key areas, the untapped skills employees have, who are natural teachers, and how to bring all three of these areas to benefit their workgroups. The role of the wellness coordinator is to help create a mentoring organization

Creating a Mentoring Company“A man who carries a cat by the tail learns something he can learn in no other way.” -Mark TwainAs a wellness advisor you have to examine how the company looks at leadership, and get involved. Old thinking about leadership has to radically change, sure managers and supervisor are still responsible for a myriad of tasks but they must adjust to the new reality that it gets harder and harder to compete with fewer and fewer tangible resources. That means a whole new perspective on the organization’s infrastructure and the role of leadership. The new leader has to be a mentor capable of developing within each employee, no matter what they do, the ability to anticipate and interpret and share what they are hearing and observing in the marketplace. Every member of the team must become a learner and teacher and share in real time unfolding trends, client observations and wishes.

The Role of The Mentor Leader

As a wellness mentor leader your task is to build a shared recognition of evolving roles and skills within the organization and their implications for the future. Get started by validating social media as tools make it

open to all employees. Send a loud clear message that employees, opinions and experiences are critical to the success of the group. Create a mindset which focuses on self praise for discovery of new critical information rather than just simply doing ones job. Be a visible champion of social media mentor use it, and share what you learn. Share what you have learned from whom you learned it from and what might be the implications for the future. Find your natural teachers, they come in all shapes and sizes they are the first role models that you can build a sharing team with; discover who is using social networking in your team and platforms they are using.

As a wellness mentor develop a set of questions that should always be in the forefront of employees mind and have them share their experiences with each such as:

What are people telling you not just about our service or products but things in

general and how can we take advantage of that knowledge?

What talents are we not tapping?

Who is helping you do a better job?

Mentor Wellness Leaders Know Their Colleagues and Employees

Today’s worker is more sophisticated, technically aware, and is redefining their lives around not only work but their own personal needs. The best news for employers is that social media is empowering today’s employees to take control over what they learn, how they learn and when they learn. The trick is to keep them involved and interested. The concept of down time must be eliminated; you can do this by making sure they



are posting observations they are learning through social networking. People in real time can focus on collaborative problem solving and information sharing. Such social media conversations help individuals understand that there is a collective wisdom which is non judgmental and available to them which can be as important them as to how they work independently.

Have leaders adjust employee time to meet the changing conditions and needs of the organization as a whole. They give adequate time for employees to surf the Internet, find colleagues in other business knowledgeable about things they are working on collect information that allows them to perceive what they need to adjust or adapt to enable the organization to stay ahead of competition.

Suggest supervisors throw out performance appraisals which only measure current work accomplishments; sure individual performance remains critical, but it only measures past performance you want to now need to measure employees future contributions to your team. There is no excuse if an employee is not vibrantly contributing new information to their colleagues they are functioning below what you need.

Remove any barriers that prevent individuals from using any and all social media. I mean any social media trends come in all sizes. Just look at how fads appear and disappear. Run in-services on social media including evaluations of sites. Remove any roadblocks and minimize and delays that prevent information sharing. Create and underline the expectation that each individual is responsible to directly collaborate with each other.

Record and praise what individuals are discovering and report back to the organization what the implications might be to the future of the organization.

Conclusion

“A man content to go to heaven alone will never go to heaven.” -Boethius Creating a shared understanding among all employees of the changing nature of your organization and the business climate, and its’ implications is imperative to your organization. Only an organization that devotes itself to mentorship will be relevant to the business tomorrow.

Give your team the gift of validation by recognizing their skills, talents and accomplishments, but also recognize what they have taught their colleagues. Never allow employees to be bored; there is a world of opportunities out there makes sure they are plugged into it.

BioDr. Wayne Weiner is a man of many talents and Interests from history, health, to state of the art business and communication technology. He is the co-founder of Bella Business Solutions, developers of innovative products and services. He has won awards as an innovative strategist and motivational leader and is nationally recognized as an expert change agent who propelled hundreds of for profit, universities and public organizations into exemplar organizations. He is also an avid writer and author of a science fiction Trilogy and three spy novels.

Join The Corporate Health and Wellness Associationwww.WellnessAssociation.com

Join The Corporate Health and Wellness Associationwww.WellnessAssociation.com

iven the continual steep rise in health care costs in an already challenging economic

environment, many employers now recognize the strategic business advantage of having a physically and emotionally healthy, engaged and active workforce. For employers, employees with chronic diseases and conditions – such as heart disease, diabetes, arthritis, and depression – are of particular concern. Research shows that individuals with chronic diseases have higher medical costs and put greater demands on the health care system. For example, health care spending is:

• 2.5 times greater for a person living with one chronic condition than for an individual with no chronic conditions;

• 7 times greater for an individual living with three or four chronic conditions compared to someone without any chronic conditions; and,

• 15 times greater for a person with 5 or more chronic conditions than for an individual who does not suffer with chronic conditions.

Additionally, with the overall aging of the American population, the prevalence of chronic diseases and co-morbidity are growing steadily. From 1996 to 2006, the average number of physician office visits increased 43 percent for diabetes and 51 percent for hypertension, while physical visits for preventive care increased by only 19.2 percent.

Furthermore, the cost of chronic diseases reaches beyond direct health care expenditures. Chronic diseases also seriously impact employee productivity and performance. Asthma, diabetes and hypertension result in an estimated 164 million workdays missed by Americans each year, with an annual cost to employers of an estimated $30 billion.

To help mitigate the effects of rising health care costs and declining employee productivity, forward-thinking employers are strategically investing in comprehensive solutions – such as health and wellness programs – that can favorably affect the health of their employees. This growing trend is creating a demand for new approaches to

GBy Steven M. Schwartz



deliver population health promotion programs that are efficacious, economical, scalable and sustainable. Digital health coaching is one such approach.

Digital health coaching is an individualized, interactive, technology-based experience that provides individuals with the knowledge and tools that they need to take a more active role in managing their health. It is driven by intelligent technology that uses behavioral science models and theories, behavior change techniques, evidence-based guidelines and education and learning theory to create personalized interactions. The transformative potential of digital health coaching is its scalability to large populations at a relatively low cost, and therefore can reach all segments of the employee health spectrum, from individuals in good health to those with a chronic or severe disease.

Self-Management Approach

Self-management is an approach to chronic care that enhances self-efficacy and teaches problem-solving skills to achieve more effective condition management, role management, and emotional management. The self-management framework focuses on the following principles, whereby individuals:

• Accept responsibility for managing their care;

• Optimize daily functioning in ways that realistically consider the limitations imposed by their condition and its treatment;

• Effectively and appropriately adjust their affective responses to their conditions; and,

• More efficiently manage their care when multiple chronic diseases are addressed in a unified manner.

Research has demonstrated that health management programs that employ self-management concepts are successful in promoting favorable behavior change (e.g. cognitive symptom management, self-reported general health, and social/role activities) and for improving self-confidence in one’s ability to manage his or her chronic diseases.

Self-management can also be a cost-effective method, in that it can reduce preventable health events that drive health care utilization (e.g. inpatient and outpatient visits). For example, people living with five or more chronic diseases average 15 medical visits a year compared to 4 visits a year for other patients. Additionally, individuals that suffer with five or more chronic conditions fill almost 50 prescriptions in a single year.

Research data suggest that digital health coaching programs – health promotion interventions that are standardized, personalized, and based on proven behavior principles and techniques – can be an instrumental component of a chronic condition self-management strategy. Digital health coaching programs can be deployed at population level, are relatively low cost and convenient, and work both independently and as complementary resources that scale higher-touch interventions.

Online Chronic Condition Management Strategy Case Study

Highmark Inc. and HealthMedia, Inc., conducted

a study that evaluated the economic effect of a scalable, convenient, online intervention designed to enhance the participant’s ability to manage his or her chronic conditions, with a particular focus on the development of self-management skills and the mitigation of

costs (both direct and indirect). For the study, researchers reviewed the data of 413 members who participated in the HealthMedia® Care® for Your Health digital health coaching program, as part of the chronic condition management strategy offered by Highmark. This group was compared to a risk-matched cohort of 360 non-participants. The intervention included a baseline general health assessment, customized action plan, tailored email newsletter, and follow-up evaluations. The study found that online digital health coaching disease management programs favorably impact employer health care costs.

Highmark’s chronic condition management services include (but are not limited to):

• Interactive voice response (IVR) telephonic outreach to members with chronic conditions;• Letter and phone call reminders for clinical preventive exams;• Educational resources that include medical management consulting and educational outreach for members and providers;• Self-management education; and,

• Complex case management.

Developed by a team of health care experts and clinical behavioral scientists, HealthMedia® Care® for Your Health is a tailored digital health coaching program that teaches people to become more independent and active, and to more successfully manage their chronic conditions. This intervention works in conjunction with Highmark health coaches to help members manage chronic conditions, such as diabetes, asthma, back pain, depression, and coronary artery disease.

The program begins with a baseline general health questionnaire, the results of which are used to customize an action plan, three e-mail newsletters, and follow-up evaluations, which

are administered at days 1, 30, 90, and 180 after program completion.

The following topics are assessed in the baseline and follow-up questionnaires and in the program content:

• Medication compliance

• Relationships with physicians and pharmacists

• Symptom management

• Lifestyle behaviors

• Emotional changes

• Work productivity

Study participants self-reported their medical history on the baseline questionnaire. On average, participants had 2.7 chronic conditions. The most common conditions reported were:

• Hyperlipidemia (39.5 percent)

• Hypertension (36.6 percent)

• Allergies (24.7 percent)

• Acid reflux/gastroesophageal reflux disease

(23.7 percent)

• Back pain (23.5 percent)

In addition, researchers reviewed the data for specific heath care expenditure trends in five categories:

• Inpatient services

• Outpatient services

• Professional services

• Pharmacy services

• Total health care costs

The ResultsThe study results indicated that online self-management interventions can be an important


CorporateWellnessMagazine.com | August 2011 35 CorporateWellnessMagazine.com | August 2011 35

and cost-effective component of an employer’s population health management strategy. The data showed a reduction in health care costs of $757 per person per year than predicted for employees who participated in the condition self-management and HealthMedia® Care® for Your Health program, versus employees who did not participate in the program.

Furthermore, participants consistently had lower utilization increases relative to non-participants in all categories except outpatient services. Although the findings showed a higher increase in outpatient services utilization for program participants than for non-participants, the overall outpatient costs and total health care costs were lower for participants. The higher outpatient service utilization by participants may be a result of the encouragement that members receive through the digital health coaching program to seek regular outpatient care to manage their chronic condition(s). This reduces the need for more aggressive medication and hospitalization. The same result has been found in other studies.

Also, members that participated in the online chronic condition self-management program had fewer annualized total hospital inpatient days and a shorter length of stay per person per year compared to non-participants.

Additionally, the estimated cost savings per person by category for study participants versus non-participants include:

• $313 for inpatient costs

• $274 for outpatient costs

• $152 for professional services

• $71 for pharmacy costs

Note: because of the use of separate predictive

models for each category, the sum of these categorical savings does not equal the $757 savings reported for total health care expenditures.

Conclusion

The prevalence of chronic conditions is growing rapidly, which puts further pressure on an already overwhelmed health care system and contributes to the steep increase in health care costs. As a result, there is a growing trend by employers to provide wellness and prevention programs to their employees with the intent to empower individuals to take greater responsibility for their health. Condition management programs that teach self-management skills and encourage preventative care are believed to yield a positive return on investment (ROI) and help people live healthier, more productive lives.

This study illustrates that the application of general self-management principles can produce a measurable ROI for employers. Furthermore, the study demonstrates the potential benefits that efficient and effective population chronic illness management programs can provide to employees.

Technologies, such as digital health coaching, must continue to be developed, tested, and – where effective – applied if we are to address the mounting health care challenges related to chronic disease management and cost containment.

Bio

Dr. Steven M. Schwartz is Research Director at HealthMedia, Inc., a Johnson & Johnson company and part of the Wellness & Prevention business. Dr. Schwartz received his B.A. in general psychology from Wayne State University, an M.A. in experimental psychology from the College of William and Mary, and a Ph.D. in clinical/health psychology from Virginia Commonwealth University.

o you repeatedly procrastinate? Do you wonder why you don’t just get

on with it? If procrastination is a “gap between intention and action” what keeps you from putting your intention into action?

You’re in good company since virtually everyone procrastinates. But not everyone is a procrastinator. Those reporting they procrastinate swelled from only 5 percent in 1978 to 20 to 25 percent today based on two recent large studies by psychologist Joseph Ferrari of DePaul University.

Procrastination is impulsivity winning out over future rewards. This is probably why it’s on the increase. Our modern world has limitless distractions: a plethora of TV channels, electronic games and Internet temptations. Referring to all of these amusements, University of Calgary psychologist Piers Steel speaking of procrastination says, “You couldn’t design a worse working environment if you tried.”

Historically, it was said procrastination was caused by perfectionism, fear of failure and rebellion against overbearing parents that one has never outgrown. Then there were the thrill seekers who profess they work best under pressure and use procrastination to create that pressure.

DBy Jacquelyn Ferguson

COLUMN


Steel reviewed 553 studies of procrastination and concluded it has four related variables regarding your task:

1. Your confidence in your ability to do it;

2. Its value;

3. Your need for immediate gratification and sensitivity to its delay;4. Impulsiveness;

He suggests about the task:

• The more confident you are, the less you’ll delay.

• Its value is determined by how much fun it will be and its meaning to you. The more fun or the more meaningful the less you’ll procrastinate.

• The need for instant gratification considers both how much time will pass before you’re rewarded for doing the assignment and how badly you need a reward to work on it. You’re more likely to finish a job due next week if it results in an immediate reward. If the reward comes much later, dawdling increases.

• Impulsiveness is determined by how easily distracted you are. The more distractible you are, the more likely you are to procrastinate.

He created a formula to predict your procrastination likelihood:

• Your confidence multiplied by the task’s importance andfun, divided by how badly you need the reward for finishing it, multiplied by how easily distractible you are.

Survival Instincts May Be Cause of Procrastination

Impulsivity, he says, is the most important part of his equation. “There’s a huge correlation between procrastination and impulsivity … that has to do

with evolution. Procrastination reflects the difficulty of coping with some aspects of modern society with hunter-gatherer brains because our forebears lived in a world without delay. For them … meat kept for three days and danger lurked around every corner. It was a very immediate environment. We learned to value the now much more than the later to survive.”

Without going into the details about the functioning of our survival brain, he says we do less well planning for the future, where goals exist. “So, a second piece of chocolate cake wins out over a trim figure down the road.”

Four Tips to Help Conquer Your Procrastination

In spite of our survival brains contributing to procrastination by living more in the moment to survive versus the future where goals reside , you can overcome your delaying habits. Timothy A. Pychyl, procrastination researcher at Ottawa’s Carlton University suggests the following. Use his ideas in sequence since each follows on the previous one.

1. Neutralize the irrationality of human nature: Researcher Piers Steel has shown that humans are predictably illogical. We perceive future rewards as less important than the task at hand, especially if the present task is more pleasant. To counter this, use specific mental images of your future as though it were happening right now. For example, if you’ve put off saving for retirement imagine your detailed, limited retirement budget and how difficult it will be to live on it. Include inflation and the toll it takes on just getting by. Imagine perhaps having to make a choice between eating tonight and taking prescribed medication. You can’t afford both. How does this make you feel?

2. Call on emotional intelligence: When willpower fails, it’s often because short-term emotional needs


#NP Bad Meets Evil - Welcome 2 Hell #HellTheSequel

become more important than long-term goals, like procrastinating on anxiety-producing tasks by indulging in pleasant distractions. The greater your emotional intelligence the more likely you can overcome this tendency by acknowledging your negative emotions but not giving in to them. Progress on goals provides the motivation for taking another step so just get started. The negative emotions will pass.

3. Reduce uncertainty and distractions: How meaningful your task is helps determine your ability to overcome inertia. The less meaningful the goal, the less likely you’ll get started. You’re most likely to procrastinate:

• On undesirable tasks

• When you’re uncertain how to proceed

• When the task lacks structure

Along with making your task concrete (tip #1) you need to reduce the uncertainty about how to proceed. Planning is very important for movement. When it’s time to act you’ll also need to reduce distractions. Stop checking email, seek privacy as much as possible, and create an environment that supports your willpower and focus.

4. Cultivate your willpower: Much recent research

shows that willpower is like a muscle. You can extinguish it more quickly than you might imagine. When you do, a very negative consequence is losing some ability to control your behavior. To strengthen your resolve and stay on task:

• Identify a positive value that’s relevant to your task at hand. Values are wonderfully motivating. If you value independence you won’t want to depend upon anyone in retirement. Putting away more savings now would honor this value and strengthen your willpower.

• Mindfulness: Awareness is the first step in self-control, so keeping focused attention on your retirement savings goal will help you procrastinate less by strengthening self-regulation.

Other Ideas to Get You Going

Overcome “yes-but” and the procrastination it causes

To successfully procrastinate use the sure-fire “yes-but” technique: “Yes, I know that I need to get that done, but not now.” It typically works wonderfully. “I’d love to apply for that job, but I’m probably not qualified.” The “yes” indicates your interest in the job. The “but” is your excuse for not applying.


Are you a yes-buter? Dr. Arthur Freeman and Rose DeWolf, authors of The 10 Dumbest Mistakes Smart People Make, say a common reason you may procrastinate in uncomfortable situations is because you have a low tolerance for frustration. Since frustration is a fact of life you’ll need to tolerate disagreeable circumstances better if you expect to overcome this very effective stalling practice.

Acknowledging the unpleasantness of your task can help. But don’t go overboard. If you exaggerate how distasteful the job is you’ll be right back into “yes-but.” Instead, consciously acknowledge the due date of your commitment and at minimum create a plan of action as described below.

To move forward change your “yes-but” to “yes-and.” Instead of, “I’d love to apply for that job, but I doubt I’m qualified”, say, “I’d love to apply for that job and I need to find out about the requirements.” “Yes-but” gives you excuses. “Yes-and” shows you the steps you’ll need to take.

“Delay is the deadliest form of denial,” C. Northcote Parkinson said. So when you hear yourself use the “yes-but” as an excuse for procrastination immediately do the following:

• Write your project’s goal, e.g., “To land this job.”

• List all of the steps you’d need to take to get it, breaking them down into bite-size pieces:

o Get the contact information for the organization for which you want to work.o Find out the qualifications.o If you meet them, fill out an application. o Follow up with a phone call to the employer.o Etc.

• Write down a deadline for each and every step.

• Commit to each step, one by one.

If you’re unwilling to follow through with these steps, decrease your stress by admitting to yourself that you have no intention of looking into this job. Honesty requires being conscious of your choices. “I choose not to pursue this job because I assume I’m not qualified.”

Staying conscious increases the likelihood that one day you’ll make a different choice. Perhaps you’ll even pursue a job you fear you’re not qualified for by throwing caution to the wind and researching whether or not you are. Get out of the procrastination mode and instead focus on a starting point. Each time you hear yourself say “yes-but” stop and instead say “yes-and” to see what the implied required steps are so you can start your action plan. Often, overcoming procrastination is simply taking that first step.

Chronic Procrastinators: Just Get Going

“Never put off till tomorrow, what you can do the day after tomorrow.” - Mark Twain

Seriously, procrastination is a frustrating habit. Since it’s a learned one it can be overcome but only if you become conscious when you’re doing it.

If you’re a chronic procrastinator you need to acknowledge when you say “later” you really don’t mean it. Thousands of “laters” create thousands of opportunities lost. To stay conscious when you say “later” follow up with, “Later to me means never. Do I really want to get this done or not?”

Also become very cognizant of your avoidance habits, which you’ve probably perfected to the point that you engage in them automatically and unconsciously whenever you face an unpleasant task. Keep a journal of your thoughts and emotions when you’re delaying:

• Choose something you procrastinate on regularly.


• Describe the activity you put off. Is it unpleasant,

confusing, uncomfortable or threatening?

• Write what you’re thinking and feeling when you begin to delay. For instance, “I can’t concentrate enough right now.” Continue to record what you say and/or what you do to prolong your postponement.

• Ask yourself why you’re avoiding action. Is it a legitimate reason or just an excuse? Also answer, “What discomfort am I evading?” Usually your answer is based on some unfounded fear.

• What’s your outcome?

To get going try these ideas:

• Timothy A. Pychyl suggests, “Follow the 10-minute

rule.” Acknowledge your desire to procrastinate then do the task for ten minutes anyway. Initiating is the hardest step for chronic procrastinators. After working on itfor 10 minutes decide whether to continue. Once you’re involved, it’s easy to stay with the task.

• If you have something to do, do it now or schedule it. If it’s not worth the amount of time it takes to schedule, it’s not going to get done later.

• For larger projects write out your goal and list each step you have to take to accomplish it. Schedule each step in your calendar.

• Invest your energy on the important and ignore the trivial.

• Don’t demean yourself when you dally because it makes more likely you’ll continue procrastinating.

• Keep a next steps list for all projects with an estimate of how long it’ll take to accomplish each one. If you have 15 minutes, look over your lists for something you can get done in less than 15 minutes. This furthers your progress in bits and pieces, which is great for those who procrastinate.

• Put the task right in front of you to avoid “out of

sight out of mind.”

• Public commitment: Tell someone what you’re working on and when you’ll have it finished.

• Reward yourself when you’ve completed it. Do something just for fun. Give yourself a mental complement.

Ultimately you must put your energy where your goals are. If you don’t attain them, make your goals smaller and easier to attain expanding them as you progress. Putting off the less pleasant for the more immediate and more attractive is very normal. We all do it sometimes. But for chronic procrastinators remember the most important thing to do is just start!

“The journey of 1000 miles begins with a single step.” - Mao Tse-tung

Move toward your goal by taking one step at a time.

So what are you waiting for? Get going!Bio

Jaquelyn Ferguson is the founder of InterAction Associates, her speaking and coaching firm. For over 25 years Jackie has designed and presented keynotes and workshops on stress management, diversity, workplace harassment, motivation, and communication skills.

Jackie is also a Stress & Wellness Coach helping people achieve more success with less stress. Jackie is the author of “Let Your Body Win: Stress Management Plain & Simple” and a weekly column “Stress for Success” in Gannett Newspaper, at www.letyourbodywin.com.


orkplace wellness is an important focus for businesses, but it is even more important in health care

work environments where staff model health behavior. What activity can be offered to employees within the workplace at a low cost and provide participants with the opportunity to fully engage body-mind-spirit components of a workplace wellness program?

This holistic activity has been around for thousands of years, and it’s called yoga.

At Mayo Clinic in Rochester, Minnesota, the Departments of Radiology and Surgery sponsored a “yoga at work” activity. These departments have collaborated to develop an innovative RadSurg LiveWell program focused on providing a variety of health promotion activities for employees.

The program derives part of its title from an institutional program. LiveWell is the name of Mayo Clinic’s health promotion program aimed at helping employees find the right

By Kathleen Sundt

By Susanne M. Cutshall

By Lisa M. Schrader

By Barbara S. Thomley

By David B. Jasperson

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programs, tools and support to make or continue with healthy lifestyle choices. An important component of the LiveWell health promotion program at Mayo Clinic in Rochester is its employee health facility, The Dan Abraham Healthy Living Center (DAHLC), through which members have access to a wide range of activities, training, and programs, including yoga classes. The RadSurg LiveWell wellness program extends the outreach of DAHLC by bringing activities into the workplace and offering additional options for employees who may be intimidated by a health club setting or are unable to fit it into their schedule (Jasperson 2010).

An overarching goal in planning a yoga workplace activity was to meet participants where they were on their own personal journey of health, wellness and self acceptance. Hence, the yoga activity was entitled Self Acceptance Through Yoga: A 40-day commitment to nurturing acceptance and inner peace (SATYA).

The Inspiration: Yoga-Based Program Pilot Study

A previously conducted yoga-based study at Mayo Clinic in 2009 provided the impetus for the RadSurg LiveWell program’s eventual collaboration on a yoga activity. In this study, 58 generally healthy individuals ranging in age from 24 to 76 years participated in a six-week yoga study, in which pre- and post-study measures were taken. These were self-selected employees, with existing membership to the DAHLC, who were invited

to participate in the study. During this six-week study, participants practiced yoga daily, documented food intake, responded to personal reflection questions, and maintained a meditation practice.

Comparison of baseline and final measurements revealed notable improvements in physical attributes (weight, flexibility, etc). Quality of Life measurements showed statistically significant improvement overall which included physical, mental, emotional and spiritual markers. This pilot study suggests that a yoga-based wellness program is both feasible and efficacious. (Thomley et al 2011).

The RadSurg SATYA Activity

The SATYA planning team wanted to design an activity involving both the physical and non-physical aspects of yoga. Although the eight limbs of yoga (social behavior, inner discipline, postures, breath control, inward attention of the senses, concentration, meditation and absolute bliss) are not tied to any one religion or culture, considerations of autonomy, religious sensitivity, perceived social propriety and unwritten company rules can make traditional Western

companies wary of integrating anything other than the physical postures of


yoga into their workplace culture. It was decided that the limbs of social behavior (Yamas), inner discipline (Niyamas), postures (Asana) and breath control (Pranayama) would be both palatable and transferable to a business setting in a small, self-selected group of activity participants. A six-week activity was developed for a self-selected group of employees in the RadSurg LiveWell program with the hope that it would be sufficient time to develop a habit in some participants. Prior to the start of the activity, registrants were encouraged to attend an orientation where introductions were made, journals were handed out, and frequently asked questions about yoga were proactively addressed. Individuals were asked to set intentions (similar to, but more forgiving than goals) for their time in the program, a daily home yoga practice was encouraged, and the components of the activity were explained.

When an employee enrolled in the activity, they were sent a confirmation email that contained a link to an electronic survey (Harris et al 2009). The survey collected general demographic information, as well as prior yoga experience. It also asked respondents to assess their current state of mental, physical, emotional and spiritual well-being, as well as overall quality of life and level of social activity. Participants were asked to rate these aspects again after completing the SATYA activity (Figure 1).

Each week, a new Yama/Niyama was articulated through e-mail and emphasized in the sessions via formal readings and informal education during class. The journal, with room for daily entries throughout the program, was designed with quotes and probing questions highlighting the week’s focus (Figure 2). While nutrition and diet were not intended to be a primary focus of the program, it is common that people associate themselves with their body shape and eating habits. For this reason, a portion of each day’s journaling space was also dedicated to recording items that participants were proud to claim they ate, and ones that they were

less proud of but still willing to claim. The rationale behind this approach to nutrition self-assessment was to minimize self-judgment and instead encourage participants to simply observe. Through observation and mindfulness, people may begin to make healthier choices.

Classes were designed to minimize perspiration and enable a smooth transition between the program and the work day. Each class began with a brief reading or discussion of the week’s Yama/Niyama, followed by a calming component that encouraged participants to focus on their breath and the present moment. Gentle stretches to increase flexibility were followed by a series of standing poses to increase strength and balance –the challenge of all these postures increased gradually over the six-week program. Each session ended with twists, stretches, and a final resting/meditative period. Instructors were focused through their teaching and verbiage to support emotional and physical safety for all attendees. This process progressed throughout the six-week duration of the activity.

Collaboration

A key factor in the success of this program was the multi-departmental collaboration in its design and conduct. By bringing together varying types of experience and expertise, the planning team was able to design a robust program that supplemented other workplace offerings.

The RadSurg LiveWell program receives input and guidance for program ideas from a group of Wellness Champions. These Champions are employees from the work units of both departments who help to “champion” program activities and events and meet monthly as a group. Several Champions have experience with yoga and agreed that a robust yoga program in the workplace would be innovative.

A series of meetings were initiated to explore the possibility of a yoga activity. Meetings included two


participants from the 2009 yoga study, one of the 2009 Yoga study co-leaders, and two RadSurg LiveWell leaders. The three yoga instructors had recently completed yoga teacher training and were excited to have a venue to develop their newly acquired skills and share their knowledge.

Challenges & Barriers

Several challenges were addressed prior to bringing this yoga activity to busy Radiology and Surgical practices:

• Selecting the length, frequency and time of day at which sessions were offered

• Identifying and securing acceptable space and locations for sessions

• Accommodating instructors’ schedules and availability

• Managing preconceptions about yoga by potential participants

• Designing promotions that appeal to both men and women as well as varied body shapes and sizes

• Developing a program that would be appropriate for varying levels of yoga experience, including novices

Employees in the Surgery and Radiology departments work varied schedules so any activity would ideally have multiple times available for staff to attend. After meeting with RadSurg LiveWell Champions, it was decided to schedule an early morning session in one location (the main clinic location) and a later morning session at a different campus location (Saint Marys Hospital).

Space used for the sessions needed to accommodate several yoga mats on open floor space. Conference rooms with movable tables and stackable chairs were selected for ease of configuration and set up. Locations were the same for a majority of the sessions, but some

had to be adjusted due to prior schedules for these rooms. Reminders about room changes were clearly communicated to all participants by e-mail.

Along with the needs of the potential participants, the schedules of the instructors were considered when determining the frequency and timing of sessions. The best schedule identified was three days per week, with morning and lunchtime sessions. Each session lasted 40 to45 minutes. The three instructors worked out a schedule to accommodate all sessions and allow for backup for each other.

The promotional posters emphasized that this program was “come as you are” with no special clothing or experience required. They also made an appeal to both men and women and focused on the stress management benefits of yoga (Figure 3). RadSurg LiveWell Champions were utilized to help spread the word about the program throughout the departments. The simple enrollment form was linked on the RadSurg LiveWell website.

Results/Outcomes

The SATYA workplace activity achieved sustained participation over the entire six weeks from 24 of the 31 participants who completed the pre program survey, for a retention rate of just under 80 percent.

As noted earlier, participants completed a questionnaire regarding aspects of quality of life and physical, emotional, social and spiritual well-being prior to the start of the workplace activity and after completion. The median rating on the multiple pre and post participation self-assessments showed positive increase for each of the measures, as the following graph shows: (next page)

Several participants shared personal stories with the yoga instructors. One participant, who sings at weddings, consciously used breathing techniques learned in the program to calm herself before her vocal performance. A grandmother who had been


unable to get down on the floor and play with her young grandchildren gained the physical flexibility to do so after participating in the yoga sessions. One woman found the program a “lifesaver” in handling her emotional and physical distress as she dealt with a terminally ill family member. Others remarked on


the noticeable reduction in neck and shoulder tension created by their daily desk and computer work.

Anecdotally, participation in this workplace program provided benefits that extended far beyond the workplace and included elements of mind, body, and spirit. Comments below express a sample from three participants regarding what area of their life improved the most with this activity.

• “My physical self. I am motivated to continue regular exercise and continue with the things I have learned.”

• “This program helped my emotional well being the most.”

• “I have had an increase in my spiritual well being…”

Several of the participants sought out experiences to continue their yoga practice after SATYA finished.

A few, who were members of the DAHLC at Mayo Clinic, joined scheduled classes offered there. Others found yoga programs within the local area or purchased DVDs for use in their homes.

Conclusions and Recommendations

The SATYA yoga at work activity successfully engaged body, mind and spirit components of a workplace wellness activity and appears to have led to some sustainable life changes for several participants. In addition, this activity is an example of how collaboration among key individuals and departments can lead to an effective health promotion in the workplace. Based on the survey results and comments from participants, this yoga event had positive results for many. Several people commented about wanting to continue with this activity beyond the pilot time.

The SATYA results suggest that there are benefits to offering a yoga activity in the workplace to promote health and manage stress. Based on this experience, the RadSurg program will offer this activity on a yearly basis with discussion on what tips for yoga could be incorporated into everyday activities. Preliminary

data suggests the potential for formal research protocols incorporating yogainto the workplace. Namaste.

BioDavid B. Jasperson, MA is a Quality Improvement/Education Specialist for the Department of Radiology at the Mayo Clinic in Rochester, MN, and also serves as the Program Coordinator for RadSurg LiveWell. He can be contacted at [email protected].

Lisa M. Schrader, MT, MBA is a yoga instructor trained at the 200-hour level in Rochester, MN, and an Operations Coordinator in the Mayo Clinic Center for Translational Science Activities. She can be contacted at [email protected].

Barb Thomley is a Coordinator for the Complementary and Integrative Medicine Program at the Mayo Clinic in Rochester, MN and is a yoga instructor in the Rochester community. She can be contacted at [email protected].

Kathleen Sundt, RN, PMA®-CPT, RYT-200, owns Gentle Pilates and Yoga in Boston, MA and teaches clients privately. She can be contacted at [email protected] or gentlepilatesandyoga.com.

Susanne M. Cutshall, MS, RN, CNS is an Integrative Health Specialist for the Department of Surgery at the Mayo Clinic in Rochester, MN and is a wellness champion for the RadSurg LiveWell Program. She can be contacted at [email protected].

Works Cited1. Jasperson, David B. “RadSurg Wellness Program: Improving the Work Environment and the Workforce Team.”

Radiology Management. January/February 2010: 48-53.2. Thomley, Barbara S., et al. “Effects of a Brief, Comprehensive, Yoga-Based Program on Quality of Life and

Biometric Measures in an Employee Population: A Pilot Study.” Explore. 7.1 (2011) : 27-29.3. Harris, Paul A., et al. “Research electronic data capture (REDCap) - A metadata-driven methodology and work-

flow process for providing translational research informatics support.” J Biomed Inform. 42 (2009) : 377-81.


Corporate Wellness Magazine August 2011

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Transcript of Corporate Wellness Magazine August 2011