Creating a Culture of Health - IAWHP · 2012. 4. 19. · Free Powerpoint Templates Page 0 Creating...
Transcript of Creating a Culture of Health - IAWHP · 2012. 4. 19. · Free Powerpoint Templates Page 0 Creating...
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Creating a Culture of Health
William B. Baun, EPD, CWP, FAWHPWellness Coach, MD Anderson Cancer Center
President National Wellness Institute
713-745-6927; [email protected]
2012 IAWHP
Global Worksite
Health Symposium
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Surgeon General calls for a
healthy and fit nation
"I am calling on all Americans to
join me in a national grassroots
effort to reverse the current
obesity crisis. My vision for a
healthy and fit nation includes
showing people how to choose
nutritious food, add more physical
activity to their daily lives, and
manage the stress that so often
derails their best efforts at
developing healthy habits."
America’s Doctor
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A Call to Action: Creating a Culture
of Health
A bold call to action
for hospitals and their
employees to be
leaders in creating a
culture of health
American Hospital
Association (2010)
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Culture is the personality of
an organization
―You see culture in the way the furniture is arranged, what people brag
about, what they are rewarded for doing and what they wear.‖
Whitmore (2008) SHRM
―…corporate culture is no longer the relevant topic, I think the relevant
topic is macro culture (where different nationalities and occupations play
out), and micro cultures where you have problems in the operating room
and in teamwork because you have people of different occupations and
cultures that all interplay.‖ Edward Schein (2011) Forbes
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Why work at
the culture
level?
Culture is a critical factor in creating and
supporting organizational values, directing
behaviors, and uniting employees. It is
vital in creating value for shareholders,
customers, and the communities where these businesses are located.
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Organizational culture facilitates • Supports organizational strategy – when
strategy and culture reinforce each other,
employees find it natural to be committed to the
strategy
• Employee self management – sense of shared
identity and commitment
• Stability – sense of continuity and satisfies
need for predictability, security, and comfort
• Socialization – internalization of organizational
values
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Definition of culture of health―In a culture of health, employee well-
being and organizational success are
inextricably linked. It aligns
leadership, benefits, policies,
incentives, programs and
environmental supports to reduce
barriers to active engagement and
sustainability of healthy lifestyles
across the healthcare continuum.‖Baun (2009)
http://www.centervbhm.com/lb/workset.html
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Culture of health born from years
of successful safety cultures
Culture of safety is one in which employee behavior is guided
by safety procedures, norms, and supports that encourage a
safe working environment. Safety behaviors are incorporated
into the vision and goals of leadership.
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2011 C. Everett Koop Winners
Alcon Laboratories
―With a mission of cultivating a culture of health, Alcon has supported
employee wellness since 1993. Beginning with healthy nutrition and
fitness activities, Alcon‘s program has since grown and expanded to
incorporate a broader set of initiatives coupled with incentives. In 2010,
Alcon‘s employees participated in an average of 31 unique wellness
activities with 63% completing a health assessment and biometric
screenings.‖Eastman Chemicals
"Eastman is honored to receive the C. Everett Koop award in
recognition of the company's efforts in building a culture of
health," said Edna Kinner, Vice President of Human Resources.
"This award not only reflects Eastman's commitment to health
improvement, but the significant involvement of Eastman men and
women with their personal health."
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2011 C. Everett Koop Winner
Prudential Financial
‗With strong statements of support from the CEO and senior leadership,
Prudential‘s commitment to a healthy culture runs deep. The organization
has developed a well-integrated employee wellness program that offers
discounts on healthy food in cafeterias, provides onsite health clinics, as well
as exercise opportunities at an onsite fitness center, and works with suppliers
to update vending machines with nutritious snacks. By creating a supportive
environment and empowering individuals to demonstrate personal
accountability for health, Prudential has helped its employees improve their
health behaviors.‘
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Climate…the “yeast” in
cultural change
Sense of Community
Three work climate
factors when abundant
can aid in a smooth shift
to a culture that values
health & well-being…
Allen (2008)
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Corporate climate factors
Shared Vision - Emerges when employees
have a chance to integrate their personal goals
and approaches with team or organizational goals
Positive Outlook – Drives individuals to look
for opportunities rather than obstacles – strengths
rather than weaknesses
Sense of Community – Present when
employees feel they belong and can trust one
another, includes awareness that others care
and that we have a responsibility to care for
ourselves and others
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Five c’s of culture change
• Comprehension understand the challenge
• Compassion grow a “spiritual” commitment
• Collaboration teaming between subcultures
• Coordination ideation, infrastructure &
processes
• Convergence local leadership support &
dissemination of new norms
Connors & Smith (2011) SUSTAIN
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Culture of health feeds from
bottom up and top down-Perceived as a business asset
-Recognized as having a big & important impact to the
success of the organization
-Leadership participation & encouragement
-Build a business case for senior management
-Illustrate the value proposition to the organization
-Pitch a comprehensive program
-Build unit level management champions
Culture of Health
“Ultimately, company
needs to engage people at
all levels of the organization
to drive a culture of health
forward.”Catherine Baase, MD
Dow Chemical Health Director
Employee Benefit News (2012)
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Leader ownership = driving
commitment down through other
leaders
• Driven through goal alignment and doing the ―right thing―
• Developing a clear understanding of the interface of
facilities, systems, and behaviors
• Creating enabling systems that make healthy choice easy
• Supporting organizational policies and processes that
ensure the effectiveness of enabling systems
• Overcoming the helplessness trap
The How:
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Engagement important steps
in culture change• Engagement for behavior change must first overcome
the bias not to change
• Choice architecture is how one presents, supports, and
influences behavior change and has real impact on
engagement
• Health literacy and urgency are critical components of
engagement
• Desired change must be conveyed in words and
actions that are relevant to the individuals and
meaningful to stakeholders if positive engagement is to
occur
Behavior Economics
Overcoming inertia –raising bar on financial
discomfort, change get lower
costs, don’t change pay more
Social peering – need to
look successful
Hyperbolic discounting
– you pay if you are not
compliant / increase distress
overcomes procrastination
Nayer (2009) Clinical
Therapeutics
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Big steps in creating a
culture of health
• Establish a sense of urgency
• Form a powerful coalition of supporters
• Create a vision
• Communicate the vision
• Empower others to act on the vision
• Plan and create short-term wins
• Learn from wins, consolidate, create more wins
• Institutionalize through building blocks
Modified from A Sense of Urgency,
Kotter (2008) author of Leading
Change, Heart of Change, & Buy In
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Building Blocks of culture
that shape long-term behavior change
Allen (2011)
Values
Norms Organizational
Support
Peer
Support
Climate
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Steps to build a culture of health
Step One – Assess how well your organization
supports employee health and well-being- Talk to all levels of management
- Conduct observational walk-around
- Hold focus groups , world cafes, do cultural audits
- Review current HR job climate & satisfaction surveys
Step Two – Analyze results & consider questions
- What do mgt & employees perceive as important
- Are there synergies in their perceptions & attitudes
- Supports implemented with least resource commitment
- Do you need to pilot, if so who will be mgt champion?
Step Three – Upon management approval implement the
plan
Step Four – Continue to build your formal & informal
leadership network & evaluate your progress
- Create a human capital team
- Engage your wellness committee, champs, & mentors
- Engage your external partners (EAP, fitness, benefits, etc.)
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Conducting cultural auditsA cultural audit consists of three stages: assessment, analysis and
recommendation
• Review of internal documents
• Review of print and other media (radio, TV, newspaper, magazine, web
content, etc.)
• Make site visits
• Hold focus groups
• Use surveys
• Interview with stakeholders
• Design data collection for comparison with a cultural database.
A
S
S
E
S
S
M
E
N
T
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Cultural Norms….there is a tendency to believe that behavior is only guided by
personal values, however cultural norms guide most health
behavior…
Judd Allen
Cultural Norms: the accepted and expected behavior of a culture -
“the way we do things around here.”
Balanced work life
Physical activity
Stress management practice
Existing Culture
Desired Culture
Norm Gap
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Gallup Healthways Well-Being IndexPublic and private sector leaders use the Well-Being Index to provided real-time measurement
and insights to improve health, increase productivity, and lower healthcare costs.
• Life Evaluation – present life situation &
anticipated life situation 5 years from now, etc.
• Emotional Health – daily experiences
enjoyment, happiness, sadness, anger, stress
depression, etc.
• Physical Health – sick days, energy, colds, flu,
disease burden, etc.
• Healthy Behaviors – lifestyle habits: tobacco,
eating, exercise, etc.
• Work Environment – perceptions of work
environment, job satisfaction, trust, treatment, etc.
• Basic Access – access to necessities, medicine,
enough $, health system, food, water, etc.
USA Well-
Being IndexScore Change
Well-Being
Index66.4 -0.2
Life Eval. 49.6 -0.5
Emotional
Health79.2 -0.5
Physical
Health 76.5 -0.6
Health
Behaviors63.9 +0.6
Work Environ. 47.4 -0.2
Basic Access 81.9 0.0
3/01/2012
http://www.well-beingindex.com/
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HERO Employee Health Management
Best practice scorecard
Since 2006, over 500 companies representing a board spectrum of
industries and business sectors have voluntarily completed the scorecard.
Senior leadership and corporate culture – 26% very supportive, 45%
supportive, 27.5% minimally supportive, 1.5% no support
Physical work environment – 59% fitness or walking trails, 74% smoke-free,
61% healthy food, 87% safe work environment, 79% well-lit/accessible
stairs, 58% flex time, 73% support early return to work, 45% recognition and
reward, 63% wellness activities during the work day
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Culture of health
Woven through our
programming in multiple
touch point strategies
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Program – big “P” and little “p”
Whole
Program
Specific
Interventions
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O’Donnell – AMSO
Opportunity 40%
Self confidence
Action
Skill 25%
Support
Behavioral efficacy
Self efficacy
Motivation readiness 30%
Knowledge
Awareness 5%
Modified from
O’Donnell (2005) AJHP
Benchmark study of 100 best programs
15 years of Koop Awards
375 studies focused on health impact
50 studies focused on financial impact
1,700 AJHP research manuscripts
Worksites and communities
30 year quest to synthesize complex
literature into a simple , intuitive
framework of what works best…..
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Awareness - Understanding the link between health
behavior & health conditions & the benefits of a healthy lifestyle
Announcements, Bulletin Boards,
Pamphlets, Payroll Inserts Billboards, DVD‘s, CD‘s,
Face-to-face Presentations
HRA‘s, Email, Self-Quizzes, Puzzles, Trigger Card,
Blogs, Interactive Voice Response, Websites,
Lunch-N-Learns, Health Screenings, Health Fairs,
Posters………………….…………………………….
Repetitive Exposure, Small Increments of Information,
Show-Discuss-Apply, Value of Information
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Motivation – embrace people as whole beings, help them
discover their life passion and the link between their passion and health
and well-being
Extrinsic Motivation
comes from outside the
individual
Intrinsic Motivation
comes from inside the
individual
Engaging individuals in the design & delivery
process, targeting & tailoring to meet an
individuals readiness to change
Used to engage
Produce health
behavior change
Shift
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Improving Wellness Using
Incentives
Factors that contribute to incentive use success: safe, timely, participant
centered, effective, and equitable
Simple behaviors – Yes
Program participation – Yes
Long-term sustained change – Insufficient Evidence
Complex change – Insufficient Evidence
Incentives should be applied in the context of communications, climate,
and culture of an organization
Terry & Anderson (2011)
Progressive-based
Incentives
• Considers starting point of
each individual
• Risk adjusted rather one-
size fits all
• Potential to engage those
with unattainable health
standards
• Participant-centered
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Skill – integrating the new changes into one‘s life, more than the
why change, also the how, when, where, with whom, and the what if‘s
Most
Important
Goal Setting – doubles success rate
- inspirational
- learning
- performance
Tailoring – to meet the needs of each person
- motivational readiness to change
- self efficacy {yes I can}
- behavioral efficacy {performing a behavior leads to an outcome}
- preferred learning style
*printed material *face-to-face *telephonic counseling *web-based
“Most appropriate for individuals who are ready
to take action to change behavior, transforms
motivation into action.” O’Donnell, 2005
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Opportunity – having access to the environment that
makes choosing a healthy behavior the easiest choice
Physical Environments:
healthy cafeterias, smoke
free, ergonomic furniture,
fitness center, fit stairwells,
lactation rooms, massage
areas, etc…..
Policies: smoke free, flex time,
benefits, physical activity,
vending, new child, etc…..
Employee Ownership: program committee,
champs, ambassadors, leaders, mentors,
etc…..
Ongoing Program Structure:
coaching, child care,
recreational, support, Weight
Watchers, EAP, etc…..
Organizational Culture: role models, incentive systems,
peer support, communication systems, etc…..
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AMSO success matrixWhat is the likelihood of success? Mix and match increases likelihood
of success…..
Element Low Medium High
Awareness 0 .5 1
Motivation 0 1 2
Skill 0 1 2
Opportunity 0 1 3
Likelihood of success:
5 or more points success is likely
4 or more points success is possible
3 or more points success is unlikely
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Creating and Sustaining Organizational
Culture
Cultural SymbolsCompany Rituals and
Ceremonies
Company Heroes
Stories
Language
LeadershipOrganizational Policies and Decision Making
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Culture of health key word
literature PubMed Search:
―workplace
culture of
health‖
1,461 Total
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Saihu, et al. (2012) Pregnancy in the workplace
Bugajska, et al. (2011) Role of psychosocial work factors in the development of
musculoskeletal disorders in workers
Staley, et al. (2011) Firefighters fitness, coronary heart disease, and sudden cardiac
death
Bjerkan (2011) Work and health: a comparison between Norwegian onshore and offshore
employees
Franche, et al. (2011) Examining the impact of worker and workplace factors on
prolonged work absences among Canadian nurses
Hymel, et al. (2011) Workplace health protection and promotion: a new pathway for a
healthier-and safer—workforce
Chuang, (2011) Implementing complex innovations: factors influencing middle manager
support
Henderson, et al. (2011) A framework to develop a clinical learning
culture in health facilities: ideas from the literature
Merrill, et al. (2011) The impact of worksite
wellness in small business
settings
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Merrill, et al. (2011) Evaluation of a best-practice worksite wellness program in
small-employer setting using selected well-being indices
Sirola-Karvinen, et al. (2010) Cocreating a health-promoting workplace
Della, et al. (2010) Management support of workplace HP: field test of the
leading by example tool
Goetzel & Pronk (2010) Worksite HP how much do we really know about what
works?
McDonald, et al. (2010) Workplace conversations: building and maintaining
collaborative capital
Hochart, et al. (2011) Impact of a comprehensive worksite wellness program on
health risk, utilization, and health care costs
Kuehn (2010) Creating a healthy work environment for
nursing facility
Hoxsey (2010) Are happy employees
healthy employees?
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S
U
M
M
A
R
Y
• Culture facilitates employee responsibility and
accountability
• Internalizes organizational values through socialization
• Support the organizational strategy
• Climate is the yeast in culture change: shared vision,
+outlook, community
• Engagement is first step feeding from the bottom and
top
• Leader ownership (senior, middle, self) drives
commitment
• Cultural audits establish the norm gaps
• Big P and little p operationalize a culture of health
• AMSO – O‘Donnell program model
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How will you build and sustain a culture of health?