Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

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Designing Designing Effective Effective Wellness Wellness Programs Programs Bruce Coulter, CPE Department of Labor and Industries

Transcript of Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

Page 1: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

Designing Effective Designing Effective Wellness ProgramsWellness Programs

Bruce Coulter, CPEDepartment of Labor and Industries

Page 2: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

My DiscussionMy Discussion

Wellness/Health Promotion ProgramsWellness/Health Promotion Programs Challenges in the Trucking IndustryChallenges in the Trucking Industry Designing the Effective ProgramDesigning the Effective Program

Business PlanBusiness Plan IntegrationIntegration BenefitsBenefits CultureCulture

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Workplace Health Promotion in Workplace Health Promotion in Washington StateWashington State

Current Research Findings

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Commercial Truck and Bus SafetyCommercial Truck and Bus Safety

Health and Wellness Programs for Commercial Drivers

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welcoa.orgwelcoa.org

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Why Health Promotion?Why Health Promotion?

Reduces costsReduces costs direct costs: medical insurance, health care, direct costs: medical insurance, health care,

workers’ compensation, accidents, absenteeismworkers’ compensation, accidents, absenteeism indirect costs: employee job satisfaction and indirect costs: employee job satisfaction and

driver retentiondriver retention IncreasesIncreases

Morale, productivity, overall healthMorale, productivity, overall health

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Wellness/Health PromotionWellness/Health Promotion

Employee Health and Wellness (H&W) programs Employee Health and Wellness (H&W) programs have been around for the past 30 yearshave been around for the past 30 years

Driven by:Driven by: Concern for employeesConcern for employees Need to control healthcare/workers’ comp costsNeed to control healthcare/workers’ comp costs Desire to decrease absenteeism, lost productivityDesire to decrease absenteeism, lost productivity

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What Are The Issues?What Are The Issues?Health Risk Factors (characteristics associated with Health Risk Factors (characteristics associated with

increased rates of disease)increased rates of disease) Tobacco useTobacco use ObesityObesity Lack of physical activityLack of physical activity High Blood PressureHigh Blood Pressure Poor eating habitsPoor eating habits Use of alcohol, drugs and other chemical Use of alcohol, drugs and other chemical

substancessubstances Various forms of psychological and job stressVarious forms of psychological and job stress

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CDCCDC

435,000 deaths per year435,000 deaths per year

365,000 deaths per year365,000 deaths per year

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435,000 + 365,000 = 800,000/416 = 1923 4161923/365 = 5.27 per day or 2192 people

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Qantas Gripe SheetsQantas Gripe Sheets P: Left inside main tire almost needs replacement. P: Left inside main tire almost needs replacement. S: Almost replaced left inside main tire. S: Almost replaced left inside main tire. P: Test flight OK, except auto-land very rough. P: Test flight OK, except auto-land very rough. S: Auto-land not installed on this aircraft. S: Auto-land not installed on this aircraft. P: Something loose in cockpit. P: Something loose in cockpit. S: Something tightened in cockpit. S: Something tightened in cockpit. P: Dead bugs on windshield. P: Dead bugs on windshield. S: Live bugs on back-order. S: Live bugs on back-order. P: Autopilot in altitude-hold mode produces a 200 feet per minute descent. P: Autopilot in altitude-hold mode produces a 200 feet per minute descent. S: Cannot reproduce problem on ground. S: Cannot reproduce problem on ground. P: Evidence of leak on right main landing gear. P: Evidence of leak on right main landing gear. S: Evidence removed. S: Evidence removed.

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Qantas Gripe SheetsQantas Gripe Sheets P: DME volume unbelievably loud. P: DME volume unbelievably loud. S: DME volume set to more believable level.S: DME volume set to more believable level.

P: Friction locks cause throttle levers to stick. P: Friction locks cause throttle levers to stick. S: That's what they're there for.S: That's what they're there for.

P: IFF inoperative. P: IFF inoperative. S: IFF always inoperative in OFF mode.S: IFF always inoperative in OFF mode.

P: Suspected crack in windshield. P: Suspected crack in windshield. S: Suspect you're right. S: Suspect you're right.

P: Mouse in cockpit. P: Mouse in cockpit. S: Cat installed. S: Cat installed.

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Qantas Gripe SheetsQantas Gripe Sheets P: Noise coming from under instrument panel. Sounds like a midget pounding on P: Noise coming from under instrument panel. Sounds like a midget pounding on

something with a hammer. something with a hammer. S: Took hammer away from midget.S: Took hammer away from midget.

P: Number 3 engine missing. P: Number 3 engine missing. S: Engine found on right wing after brief search.S: Engine found on right wing after brief search.

P: Aircraft handles funny. P: Aircraft handles funny. S: Aircraft warned to straighten up, fly right, and be serious. S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums. P: Target radar hums. S: Reprogrammed target radar with lyrics. S: Reprogrammed target radar with lyrics.

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Wellness Program EvolutionWellness Program Evolution

Traditional wellness programsTraditional wellness programs Topic of the month, non targeted, general Topic of the month, non targeted, general

wellness topics (nutrition, exercise, stress)wellness topics (nutrition, exercise, stress) Disease managementDisease management

Comprehensive campaign on a major health riskComprehensive campaign on a major health risk Web basedWeb based

On line participation in HRA’s, initiatives, coachingOn line participation in HRA’s, initiatives, coaching

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The Hard TruthThe Hard Truth Success is varied and often tied to the efforts of Success is varied and often tied to the efforts of

internal internal champion champion Challenge is that H&W is ultimately a Challenge is that H&W is ultimately a personal lifestyle personal lifestyle

choicechoice Companies can educate, encourage and even Companies can educate, encourage and even

incentivize wellness, however, incentivize wellness, however, ultimate decision rests ultimate decision rests with individualwith individual

Human behavior is very hard to change

AND

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Factors Affecting Trucker HealthFactors Affecting Trucker Health Long workdays…sittingLong workdays…sitting

Whole Body VibrationWhole Body Vibration Static PostureStatic Posture

Bursts of highly physical workBursts of highly physical work Poor dietary choices on the roadPoor dietary choices on the road Sleep issuesSleep issues

DeprivationDeprivation DisruptionDisruption Circadian and biological rhythm interruptionCircadian and biological rhythm interruption

Days, weeks away from homeDays, weeks away from home Decentralized Decentralized

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Most Common H&F Risks for DriversMost Common H&F Risks for Drivers

Poor health habitsPoor health habits Driver injuriesDriver injuries Driver fatigueDriver fatigue Driver illnessDriver illness Regular tobacco useRegular tobacco use Overweight/obeseOverweight/obese

HypertensionHypertension Poor eating habitsPoor eating habits Lack of physical activityLack of physical activity Abuse of Abuse of

AlcoholAlcohol prescription and non-prescription and non-

prescription drugsprescription drugs OTC cold remediesOTC cold remedies Energy drinksEnergy drinks

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ATRI Survey of the Greatest Health ATRI Survey of the Greatest Health Risks Facing DriversRisks Facing Drivers

Manager results: Manager results: 1.1. Unhealthy dietUnhealthy diet2.2. ObesityObesity3.3. StressStress4.4. Uncontrolled Uncontrolled

hypertensionhypertension5.5. Sleep disordersSleep disorders6.6. Drug/Alcohol useDrug/Alcohol use

Driver results:Driver results:1.1. Sleep disordersSleep disorders2.2. Drug/Alcohol useDrug/Alcohol use3.3. StressStress4.4. ObesityObesity5.5. Unhealthy dietUnhealthy diet6.6. Uncontrolled Uncontrolled

hypertensionhypertension

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Top H&W Program ActivitiesTop H&W Program Activities

Exercise/physical activity Exercise/physical activity opportunitiesopportunities

Nutrition Nutrition training/informationtraining/information

Weight management Weight management Nicotine prescriptions Nicotine prescriptions Tobacco cessation Tobacco cessation Responsible alcohol use Responsible alcohol use Cardiovascular disease Cardiovascular disease

prevention prevention

Medication management Medication management Disease management for Disease management for

issues such as diabetes and issues such as diabetes and hypertensionhypertension

Flu shots Flu shots Fatigue awareness Fatigue awareness Screening for sleep Screening for sleep

disordersdisorders Focus on ergonomics (cab Focus on ergonomics (cab

comfort)comfort)

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Driver SurveyDriver Survey

What can be done to get more drivers involved in H&W What can be done to get more drivers involved in H&W program?program?Offering weight room/exercise equipment for driversOffering weight room/exercise equipment for driversStart a company sports teamStart a company sports teamGovernment mandate on H&W program participationGovernment mandate on H&W program participation

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Drivers – Components Offered and Drivers – Components Offered and Utilized the MostUtilized the Most

Employee health risk appraisalEmployee health risk appraisal

Nutrition & diet Nutrition & diet advice/assistanceadvice/assistance

Weight management programWeight management program

Physical fitness programsPhysical fitness programs

Blood pressure screeningBlood pressure screening

Regular distribution of H&W Regular distribution of H&W materialsmaterials

Safe driving practices and Safe driving practices and promotion of seat belt usepromotion of seat belt use

Makes healthy food options Makes healthy food options availableavailable Encourages drivers’ family Encourages drivers’ family members to participate in members to participate in H&W programsH&W programs

Ensures all vehicles are Ensures all vehicles are maintained in ergonomically maintained in ergonomically sound conditionsound condition

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United States Preventive Services Task Force United States Preventive Services Task Force (USPSTF)(USPSTF)

HypertensionHypertension Lipid disordersLipid disorders ObesityObesity Tobacco useTobacco use Breast, cervical, colorectal cancersBreast, cervical, colorectal cancers

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Advisory Council on Immunization Practices Advisory Council on Immunization Practices (ACIP)(ACIP)

Annual Influenza Vaccination for those over 50Annual Influenza Vaccination for those over 50

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National Commission on National Commission on Preventive PrioritiesPreventive Priorities

Ranked preventive care by health impact and Ranked preventive care by health impact and cost-effectivenesscost-effectiveness Tobacco use Tobacco use screening and cessation programsscreening and cessation programs

42,000 deaths averted annually42,000 deaths averted annually Colorectal screeningColorectal screening

14,000 deaths averted annually14,000 deaths averted annually Influenza vaccinationInfluenza vaccination

12,000 deaths averted annually12,000 deaths averted annually

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Washington Workers Washington Workers Behavioral Risk Factor Surveillance System (BRFSS) dataBehavioral Risk Factor Surveillance System (BRFSS) data

76.3% do not eat enough fruits and vegetables76.3% do not eat enough fruits and vegetables 61.7% are 61.7% are overweight or obeseoverweight or obese SmokingSmoking

32.4% uninsured32.4% uninsured 14.8% insured14.8% insured 3 times as common in homes with annual income3 times as common in homes with annual income< $25,000 than households with incomes >$75,000< $25,000 than households with incomes >$75,000

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ResourcesResources

Guide for Community Preventive Services

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Design of an Effective ProgramDesign of an Effective Program

Business Plan (ROI, P/L, PDCA)Business Plan (ROI, P/L, PDCA) IntegrationIntegration BenefitsBenefits CultureCulture

Page 28: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

Business PlanBusiness Plan Health Promotion is at the level of Senior Health Promotion is at the level of Senior

Management TeamManagement Team Reports relevant measures regarding the human Reports relevant measures regarding the human

resourceresource Costs and cost savings using health metricsCosts and cost savings using health metrics

Budget to cover all screenings and prevention activitiesBudget to cover all screenings and prevention activities In current corporate environments capital is distributed by In current corporate environments capital is distributed by

demonstrated need and whether the capital distributed was demonstrated need and whether the capital distributed was effectively used to help the bottom lineeffectively used to help the bottom line

Reported in Annual Report to ShareholdersReported in Annual Report to Shareholders

Page 29: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

IntegrationIntegration

New Employee OrientationNew Employee Orientation Benefits sign upBenefits sign up

Tiered PremiumsTiered Premiums Newsletter to FamilyNewsletter to Family Annual HRA (mandatory for benefits)Annual HRA (mandatory for benefits)

Baseline dataBaseline data Benefit programming (free)derived from HRA ResultsBenefit programming (free)derived from HRA Results

Page 30: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

BenefitsBenefits Free Primary, Secondary and Tertiary Free Primary, Secondary and Tertiary

Prevention Prevention Free screeningsFree screenings

MammographyMammography ColonoscopyColonoscopy BPBP CholesterolCholesterol

Free Tobacco Cessation ProgramsFree Tobacco Cessation Programs Support for existing conditions Support for existing conditions (HBP, diabetes)(HBP, diabetes)

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BenefitsBenefits Percent of employee health insurance costs Percent of employee health insurance costs

should be consistent with their participation in should be consistent with their participation in the programthe program

Discounts begin with completion of an HRADiscounts begin with completion of an HRA Discounts increase with participation in Discounts increase with participation in

relevant programmingrelevant programming Full discount after demonstration of reduced Full discount after demonstration of reduced

risk (lowered BP, smoking cessation)risk (lowered BP, smoking cessation)

Page 32: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

Evaluating EffectivenessEvaluating Effectiveness

Employee behavior is often measured by health risk appraisals that Employee behavior is often measured by health risk appraisals that have low participation rates and overrepresentation of health-have low participation rates and overrepresentation of health-conscious workersconscious workers

Participants are often compared with nonparticipants, resulting in Participants are often compared with nonparticipants, resulting in strong selection bias and overestimation of intervention effectstrong selection bias and overestimation of intervention effect

Workplace evaluation efforts often focus either on Workplace evaluation efforts often focus either on inputs such as program delivery that does not capture participation and behavior inputs such as program delivery that does not capture participation and behavior

change change disease outcomes, which are slow to change and may be affected by factors outside disease outcomes, which are slow to change and may be affected by factors outside

the intervention.the intervention.

PitfallsPitfalls

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Evaluating EffectivenessEvaluating Effectiveness

Practitioners working with employers can offer more Practitioners working with employers can offer more effective workplace evaluation by:effective workplace evaluation by:

continually tracking intervention delivery and employee continually tracking intervention delivery and employee participationparticipation

measuring relevant behavior change measuring relevant behavior change

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IncentivesIncentives

Better to remove disincentives than install incentivesBetter to remove disincentives than install incentives Barrier-reduction interventions, such as eliminating Barrier-reduction interventions, such as eliminating

out-of-pocket costs for tobacco use cessation, should out-of-pocket costs for tobacco use cessation, should take priority for 2 reasons.take priority for 2 reasons.1.1. they have the broadest reach — to workers, dependents, they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those and retirees — and can affect all workers, even those who do not participate in interventions who do not participate in interventions

2.2. financial barriers are most important for low-income financial barriers are most important for low-income workers with limited meansworkers with limited means

Page 35: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

BenefitsBenefits

Wellness Programming should be part of the Wellness Programming should be part of the benefits packagebenefits package

HRA should be a requirement for employees HRA should be a requirement for employees to receive benefitsto receive benefits

Tobacco/alcohol cessation should be fully Tobacco/alcohol cessation should be fully fundedfunded

Screenings should be fully fundedScreenings should be fully funded

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CultureCulture

Culture comes from management walking Culture comes from management walking their talk. their talk.

Signs don’t work, actions do.Signs don’t work, actions do. Celebrating success, learning from failure.Celebrating success, learning from failure. If your drivers are your most valuable If your drivers are your most valuable

resource, they need to feel that.resource, they need to feel that.

Page 37: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

Other areas to addressOther areas to address

DepressionDepression MSDsMSDs Sleep DisordersSleep Disorders Stress Stress Substance AbuseSubstance Abuse

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How Do I Get Started?How Do I Get Started?

Remember – H&W program does not need to be all Remember – H&W program does not need to be all encompassing to begin to address driver health encompassing to begin to address driver health issuesissues

Small, incremental steps will make a differenceSmall, incremental steps will make a difference

Make sure commitment to improving driver H&W Make sure commitment to improving driver H&W starts at the top and is communicated as suchstarts at the top and is communicated as such

Page 39: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

How Do I Get Started?How Do I Get Started?

Analyze health care and w/c claims to identify most Analyze health care and w/c claims to identify most prevalent health risks prevalent health risks

Develop your comprehensive plan with representatives Develop your comprehensive plan with representatives from labor and management and your championfrom labor and management and your champion ScopeScope Mission statement, measureable goals and objectivesMission statement, measureable goals and objectives MeasurementMeasurement Realistic budgetRealistic budget Criteria for success (five year plan)Criteria for success (five year plan)

Page 40: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

How Do I Get Started?How Do I Get Started?

Implement an HRA which will be mandatory if Implement an HRA which will be mandatory if employees are to receive free health benefitsemployees are to receive free health benefits Legal needs to weigh in on HIPAA, and health insurance Legal needs to weigh in on HIPAA, and health insurance

security.security.

Page 41: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

Starting Small Starting Small

Mail monthly H&W info to drivers’ homes for driver Mail monthly H&W info to drivers’ homes for driver and familyand family

Dedicate section of company newsletter to H&W Dedicate section of company newsletter to H&W issuesissues

Remember the power of peer pressure and peer Remember the power of peer pressure and peer influence - drivers provide the best testimonials for influence - drivers provide the best testimonials for one anotherone another

Meet employees where they are.Meet employees where they are.

Page 42: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

Stages of ChangeStages of Change Pre-contemplationPre-contemplation

Contemplation Contemplation

Preparation Preparation

Action Action

Maintenance Maintenance

Termination Termination

Page 43: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

It Didn’t Work… It Didn’t Work… Not convenient/not accessible, particularly for over-the-road driversNot convenient/not accessible, particularly for over-the-road drivers

Takes too long to see the results – set goals too highTakes too long to see the results – set goals too high Lack of management support (management not healthy either)Lack of management support (management not healthy either)

No one assigned to manage the wellness programNo one assigned to manage the wellness program

Failure to involve front-line managementFailure to involve front-line management

Championing the program often doesn’t start at the topChampioning the program often doesn’t start at the top

Actions don’t support the message (e.g., serving donuts or pizza as Actions don’t support the message (e.g., serving donuts or pizza as a snack or meal during wellness training)a snack or meal during wellness training)

Page 44: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

It Didn’t Work… It Didn’t Work…

Champion gets program going and then gets promoted or leaves; no Champion gets program going and then gets promoted or leaves; no depth in management to carry ondepth in management to carry on

Missing a clear statement of philosophy, purpose and goalsMissing a clear statement of philosophy, purpose and goals

Ineffective communicationIneffective communication

Failure to involve employee’s spouse/family - drivers need support on Failure to involve employee’s spouse/family - drivers need support on home front to reinforce the message, change diet, reduce stress, etc.home front to reinforce the message, change diet, reduce stress, etc.

Unrealistic budgetUnrealistic budget

Work culture/environment is unsupportive – vending machines, Work culture/environment is unsupportive – vending machines, smoking areassmoking areas

Page 45: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

It Will Work… It Will Work…

Do your homework to know what the H&W issues areDo your homework to know what the H&W issues are

Set realistic goals and objectives AND performance measuresSet realistic goals and objectives AND performance measures

Commitment must be top-downCommitment must be top-down

Smart small and dedicate resources (human and financial) to each Smart small and dedicate resources (human and financial) to each stepstep

Empower drivers to be a part of the process including Empower drivers to be a part of the process including determination of program componentsdetermination of program components

Encourage and foster teamwork among drivers toward common Encourage and foster teamwork among drivers toward common goalgoal

Page 46: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

My RecommendationsMy Recommendations Find and maintain a championFind and maintain a champion Budget for programs completelyBudget for programs completely

If you believe in programs, fully fund themIf you believe in programs, fully fund them Eliminate dis-incentivesEliminate dis-incentives Meet people where they areMeet people where they are Stay with itStay with it

Understand that the participation rate will be low for some timeUnderstand that the participation rate will be low for some time Integrate wellness and safety and health, they belong Integrate wellness and safety and health, they belong

together anyway (Health and Productivity).together anyway (Health and Productivity). Wellness is a performance measure.Wellness is a performance measure.

Page 47: Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries.

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