Posts from — December 2008

Evaluation of successful Employee Wellness Initiatives has revealed several key Company Health Promotion Initiative strategies to increase Company Health Promotion Initiative effectiveness and impact overall Soldier health.

Strategy #5: Using a small number of targeted priorities maintains Company Health Promotion Initiative focus.
• Needs assessment data can be used to establish leading health needs and also high risk populations.
• Choosing a handful of specific health needs on which to focus will maximize efficient use of resources.
• Keeping the Company Health Promotion Initiative focus small will avoid duplication of other ongoing company Employee Wellness Programs.

Strategy #6: Use standardized processes whenever possible.

Reduce the amount of variation within your Employee Wellness Initiatives by standardizing all the processes needed for Company Health Promotion Initiative planning and startation. For example:
• Use the same spreadsheet format for data collection so that the columns are in the same order. This way you can compare information more easily.
• Reuse the same forms for enrollment and attendance. Change the heading as needed.
• Look at other Company Health Promotion Initiative processes (like registration, evaluation, marketing, etc.). What parts of those processes can be standardized?
• The Wellness and Prevention Initiatives website (http://chppmwww. apgea.army.mil/dhpw/Population/HPPiFunction.aspx) has many standardized Company Health Promotion Initiative resources in a variety of topic areas.

Strategy #7: Company Health Promotion Initiative delivery methods should be flexible and adapted to population needs.
• Delivery of products and services may depend on: company needs, training requirements, other scheduling considerations (such as work/duty schedules, school scheduling, etc.), participant preference, and/or availability of staff or space.
• Be flexible: the same produce/service delivery methods may not work for every population.
• Some company’s may want services provided to them as close as possible to the company location; other companies may prefer as many services as possible bundled together at once (regardless of location).
• Take wellness and preventive medicine beyond the walls of the business in order to meet leadership and staff member needs. Answer the question: “How can we best help leadership and Employees to fulfill their mission?”

Evaluation of successful Employee Wellness Initiatives has revealed several key Company Health Promotion Initiative strategies to increase Company Health Promotion Initiative effectiveness and impact overall Soldier health.

Strategy #1: Communication with leadership is critical
• Assess leadership priorities.
• Report Company Health Promotion Initiative outcomes back to leadership in a timely manner.

Strategy #2: Company Health Promotion Initiative planning must be driven by information.
• Determine specific needs of the target population.
• Focus on the health status of the population as a whole to establish the top health concerns.
• Data should drive decisions regarding which health needs should be addressed first.

Strategy #3: Use electronic information collection and reporting as frequently as possible.
• Centrally collected information in an electronic format is fundamental for determining population health needs.
• Electronic reporting is also very valuable when communicating Company Health Promotion Initiative outcomes to leadership and other stakeholders.
• Flexible reporting capabilities allow information to be presented as information that can support decision-making, in formats that decision-makers prefer.

Strategy #4: Multidisciplinary collaboration enhances staff member health and maximizes available resources.
• Collaboration between health disciplines increases effectiveness of Wellness and preventive medicine interventions.
• Don’t forget to look outside the business for collaboration partners.
• Optimized Company Health Promotion Initiative outcomes can be achieved by coordinating the activities of medical consultants, cadre, community agents, and funding sources.
• Bundling services together also provides the additional benefit to units by conserving training and mission time.
Implementing these strategies can improve Company Health Promotion Initiative effectiveness and optimize available resources.

Changing health-related behaviors is a difficult challenge. Incorporate the tools below into your Wellness initiatives to assist members in successfully changing health behaviors.

Tool #1: Establish effective goals
• Focus on areas that can impact the overall goal.
• For example, if the overall goal is to lose weight, the most productive areas to focus on are the dietary and activity changes that will lead to long-term weight loss.
• For example, stress management and improving self-esteem may also impact weight loss; however, improving relationships, while a worthy topic, will not necessarily impact weight loss.
• Make the goals specific, attainable, and forgiving. For example:
• “Exercise more” is too general.
• “Walk five miles everyday” is specific, but may not be attainable.
• “Walk 30 minutes everyday” is specific and more attainable, but is not very flexible.
• “Walk 30 minutes, five days a week” is specific, attainable, and forgiving.
• Use a series of short-term goals to achieve the ultimate goal.
• Short-term goals break big challenges into more easily attained pieces.
• Smaller steps also provide Company Health Promotion Initiative members with encouragement and success. These small successes are critical for maintaining motivation towards a long-term goal.

Tool #2: Increase self-awareness
• Self-monitoring is useful for tracking behavioral and environmental cues that trigger a particular health behavior.
• Keeping track of health behavior status is also useful for times when progress towards a goal is difficult to measure, or when an individual is in a maintenance stage.

Tool #3: Offer rewards and motivation
• Encourage members to reward themselves for achieving small successes on the way to their ultimate goal.
• Remember that rewards don’t always have to be “things.” Words of encouragement and praise can provide powerful motivation when spoken by a teacher, instructor, parent, friend, etc.

Tool #4: Respond effectively to set-backs
• health behavior change is conceptually a continuum. However, movement along that continuum is not just in one direction. Workers can move backwards or forwards or sometimes just stay put. Communicate to members that set-backs, lapses and even staying the same (i.e., maintenance) are common for individuals trying to change behavior.
• Stress is frequently a factor in lapses and relapses. Offer a variety of stress management resources to help members better handle the stress which could trigger a set-back.
• Brain storm to create a list of potential (and probable) obstacles to participant behavior change. Then formulate strategies to meet each of those challenges.
• Improved time management and decision-making skills can be effective ways to overcome behavior change relapses.
• Offer members with information regarding the behavior change process so that they will be better prepared for the challenges they will face. A brief overview of the Stages of Change may be helpful.

Most corporations do not have the Company Health Promotion Initiative resources to address all of their health needs at once. Priorities must be set to determine the most pressing health needs. Use the steps below to prioritize company Wellness needs.

Assess the health needs of the population.

Collect information about the health needs in the community. How?

• Community- or target group-specific surveys

Establish health needs and at-risk populations.

Use the information to establish leading health needs and also high risk populations. For example:
• Obesity and overweight
• Injury prevention
• Self care

Reduce the list.

Not every health need can (or should) be addressed. Use the following questions to determine which health needs should be addressed first.
• How does the health need impact operational readiness? How big is the impact?
• What are the Upper Management priorities? How does the health need fit into those priorities?
• What are the behavioral factors affecting the health need? What is the evidence that a behavior change will make a difference? Has the behavior been successfully changed by other Employee Wellness Programs?
• What other physical, social, or environmental factors influence the health need or the target population?
• Is the health need a greater problem at the local level than in the United States population as a whole?
• Does the business have the subject matter expertise and resources to address the health need?

Develop Company Health Promotion Initiative recommendations.

Only a handful of specific health needs should be focused on in a given year. Keep the following in mind as recommendations are developed as to which specific health needs will be addressed:
• Avoid duplication of other ongoing Employee Wellness Initiatives whenever possible. Establish Employee Wellness Initiatives already addressing the health need and/or the target population.
• Establish and assess available resources. Build on existing services whenever possible.

Use the recommendations to offer tailored, targeted, integrated interventions to address the prioritized list of health needs. Prioritizing health needs will keep Employee Wellness Initiatives focused, maximize efficient use of resources, and align Wellness efforts with Upper Management goals and priorities.

References
• US Department of Health and Human Services, Planned Approach to Community Health, http://www.cdc.gov/nccdphp/publications/PATCH/index.htm.
• Implementing a Comprehensive Community Wellness and Well Being Program, presentation by CHPPM-EUR at the 2006 Force Health Protection Conference

Keeping the bottom line up front Bottom Line Up Front in Company Health Promotion Initiative will help you get and sustain Upper Management support. A Bottom Line Up Front approach will also help you more realistically measure the impact of your Employee Wellness Program.

The bottom line in Employee Wellness Initiatives answer two key questions:
• How will participant health be improved?
• What’s in it for Upper Management?

The ultimate bottom line: all roads should lead to readiness.
• Always be ready to communicate to leadership the ways that your Company Health Promotion Initiative impacts readiness.
• Think like Upper Management: what Company Health Promotion Initiative outcomes will be important from a Upper Management point of view?
• Develop line-centered language that communicates those outcomes.
• Ask members how they think a particular Company Health Promotion Initiative enhances force readiness. This input is a valuable source of information.

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

Step 1: Think about the end of the Company Health Promotion Initiative first and plan backwards.
• It has been said, “If you don’t know where you’re going, any road will get you there.”
• Before planning or implementing any part of the Employee Wellness Program, be able to answer the questions: how will participant health be improved? What’s in it for Upper Management?

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

Step 3: Determine what will be measured to show that Company Health Promotion Initiative goals were met.
• Consider what information is really needed to show Company Health Promotion Initiative effectiveness. Avoid the temptation to collect every possible piece of data. Choose a handful of important information points and stick to those.
• Think backwards when deciding what information to collect – consider how easily follow-up information can be collected when a Company Health Promotion Initiative ends. Getting follow-up information is frequently a challenge.
• Only collect information for health behaviors or indicators that the Company Health Promotion Initiative actually affected.
o For example: if the main Company Health Promotion Initiative goal is that members will walk more steps, then it may be better NOT to choose changes in cholesterol level as a Company Health Promotion Initiative outcome (unless the Company Health Promotion Initiative specifically addresses cholesterol).
• Avoid measuring outcomes that the Company Health Promotion Initiative cannot (or did not) affect.

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

Working backwards when planning and implementing Employee Wellness Initiatives is really forward thinking. Keeping the bottom line up front is a smart approach to Employee Wellness Programs.

Health Information Technology can make the entire health care system more effective and efficient by enhancing:
• Documentation (lab and test results, clinic notes, consult recommendations)
• Communication (provider to patient, provider to provider)
• Information input (templates to facilitate data entry)
• Delivery of care (documenting all patient-provider interactions in a single system)
• Chronic disease risk identification (evaluation of risk factors, recommendations for appropriate preventive services and screenings)
• Consistent recording of correct billing codes

But, adapting to Health Information Technology is a challenge.
• Health Information Technology almost always involves a “new system.” Consequently, the entire staff, from health care providers to IM/IT personnel is on a learning curve.
• Existing IT infrastructure may not be adequate, so the Health Information Technology system may be very slow, or may frequently crash.
• The new system may not have all the forms you need already in place. New forms may be needed.

Lessons learned from Health Information Technology implementation

Take advantage of as many training opportunities as possible.
• Learn as much as you can about the Health Information Technology that you need to use. Become an expert.
• Ask questions if you are unsure how to navigate the system.

Keep the big picture in mind.
• Be aware that those keeping the Health Information Technology system up and running may have a very different set of priorities. The IM/IT staff may not see your request as a priority when it is taking all their manpower to trouble shoot the new system each day.
• Other changes to the Health Information Technology system may be in line in front of yours, so be patient.

Think through changes thoroughly.
• Take time to think through a new form thoroughly. Know exactly what you want before talking to the developer.
• Don’t think in a vacuum. If you build a form, make sure it is one your staff will use and find efficient.
• Create a draft version of the form and use it before requesting that it be put into the new system.
• Be prepared to build a good case for why your form should be created. Build a stronger case if your form should be developed ahead of other requests in the queue.
• Be patient and persistent when working with a programmer/developer on a new form. Meet frequently and set up timelines and deadlines.
• Coordinate with IM/IT and the Health Information Technology contractor to see if they can support a new project in the necessary time frame.

For more information about Health Information Technology implementation, go to the Agency for Healthcare Research and Quality (AHRQ) National Resource Center for Health Information Technology at http://healthit.ahrq.gov.

Organization processes are structured activities that achieve a specific result. For example, scheduling appointments is a business process that results in an orderly work flow and timely patient care.

Company Health Promotion Initiative implementation frequently requires changes to established business processes. These changes may be simple, such as adding prescreening appointments to the scheduling process, or more complicated, like determining how time devoted to a particular Company Health Promotion Initiative will be coded.

Not all change can be affected painlessly. However, developing a plan for achieving change will overcome obstacles like:

“But we’ve always done it that way” or “But we’ve never done it that way.”

Each change situation will be different. The path to achieving change may not always be straightforward.

Lesson learned: Making small, incremental changes will be easier than trying to make one big change. It is also easier to modify a current process than to introduce a brand new one.

Develop a road map for change.

Describe the current business process.
• For example: what is the current registration process for the weight management program? Include steps for both members and staff.

Establish where the new or modified business process could fit into the current process.
• For example, prescreening appointments for the weight management program could be scheduled when members sign up OR the prescreening could be done at the first class.

Collaborate.
• Consider the change process to be a team effort. Determine everyone who will be affected by the change and get their input.
o For example, be sure to ask the personnel that set up the prescreening appointments AND the personnel that would do the prescreening for their ideas.
• Recruit one or more champions for the change. It helps if the champion has some clout.
• Get buy-in from as many employees as you can – including those that might be most resistant to the change.

Communicate.
• Don’t keep the change a secret. The more employees know, the more likely they will support a change.
• Anticipate obstacles ahead of time. Be ready to articulate concrete benefits that will result from the change – especially advantages such as costs avoided or training time conserved.

Company Health Promotion Initiative evaluation is critical for effective Wellness and will help you get Upper Management support.

Why evaluate your Employee Wellness Program?

Company Health Promotion Initiative evaluation answers these questions:
• What change(s) occurred in the target population?
• ‘What’s in it’ for Upper Management?
• Are the resources that are being used worth the outcomes that are achieved?
• Were Company Health Promotion Initiative outcomes expected? (Unexpected outcomes may have occurred.)
• What Company Health Promotion Initiative areas need improvement?

Company Health Promotion Initiative Fact of Life:

Company Health Promotion Initiative evaluation left to “chance” or until “there is time” will never happen.

• Company Health Promotion Initiative evaluation should be considered as an fundamental part of the whole plan for Wellness and not as something extra.

Where do you start?

Make it Simple. Company Health Promotion Initiative evaluation does not have to be complicated.
• Get baseline information.
• Baseline information is the health status of the target population at the beginning of the Employee Wellness Program.
• Begin by collecting just 3 or 4 key items as the baseline. You will have better success collecting follow-up information later if you only need to get a few pieces of information.
• Don’t rely only on health indicators that require lab evaluation. Also use self-report information and health indicators that are measurable without lab tests.

• Collect information that relates to readiness.
• You should always be ready to communicate to leadership the ways that your Company Health Promotion Initiative impacts readiness. Plan ahead to collect information that will demonstrate this connection.
• Think like Upper Management: what Company Health Promotion Initiative outcomes will be important from Upper Management point of view?

• It’s never too late to incorporate Company Health Promotion Initiative evaluation into Employee Wellness Programs.
• If your Company Health Promotion Initiative is already up and running and you didn’t plan for information collection ahead of time, start collecting information NOW.
• If you don’t have baseline information, then collect interim information and compare that to end-of-program information.
• Or, you can compare final Company Health Promotion Initiative outcomes to similar initiatives elsewhere.

If you can’t make any comparisons to other information, use resources like The Community Guide (http://www.thecommunityguide.org/ ) that have already evaluated the effectiveness of Company Health Promotion Initiative components. Compare the components of your Company Health Promotion Initiative to those that have been proven effective elsewhere.

Think ahead: what unexpected challenges might come up as you start your Employee Wellness Program? How could you adapt and change the Company Health Promotion Initiative to meet those challenges?

• Consider the “what if’s?”
• What if your classroom space is suddenly no longer available?
• What if you can’t hold the Health Fair in the usual place?
• Have a ‘Plan B’ (or even Plan C or Plan D) in mind for when the “what if’s” happen.

• Build a team that can help with the Company Health Promotion Initiative
• Who else could teach the health education class if the regular instructor cancels at the last minute?
• Know what areas of expertise your staff has besides their ‘main’ job. For example, find out who has excercise instructor credentials besides just the physical therapist.
• Don’t wait for a crisis before you build a network of employees that you can call on.

• Be ready to roll your sleeves up
• Jump in to fill a gap if you need to.
• YOU may have to help restock the milk case in the dining center when the Dairy Month ‘Milk Mustache’ contest results in raised sales during lunch.

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

• Simplify Company Health Promotion Initiative
• If part of your Company Health Promotion Initiative is not working, try making that part less complicated.
• For example, if getting follow-up information is not going the way you planned, then make the process to get information easier OR decrease the number of pieces of information that you collect.

• Use lemons to make lemonade
• What do you do when the Company Health Promotion Initiative doesn’t turn out exactly as you planned? Look for what did turn out. Often, the ‘unexpected outcomes’ produce positive results.
• For example, one company’s database to collect sick call data was made obsolete by a regional system. However, the company database was able to be used in a different way to track vaccination information that improved delivery of care to Employees.

Take the time to plan Employee Wellness Initiatives before they are implemented.

Effective planning enables better use of all your resources. Include all the steps below when you plan a Wellness activity.
• Do your homework – Find the science and research that support your interventions. Look for similar Employee Wellness Initiatives that already exist.
• Determine the specific health need(s) – Use these needs to target interventions to problems that are an issue for your population.
• Organize a team – A team is a resource multiplier. Network and build as many partnerships as you can.
• Make a plan, but don’t start completely from scratch. Create a written plan for your Employee Wellness Program. Look for every opportunity to take advantage of resources that already exist. Don’t reinvent the wheel.
• Select a focus – Choose one or two main target areas for Employee Wellness Programs. Address all five stages of change in the target areas rather than trying to hit every possible Wellness topic.
• Determine your resources – What assets do you have? What assets will you need? How can you fill the gaps?
• Get Upper Management support – Think like Upper Management. Communicate the value of Wellness from Upper Management’s perspective.
• Begin the activity- Be flexible. Be prepared for unexpected challenges.
• Market the activity – Keep your Company Health Promotion Initiative visible for Upper Management, line and medical personnel, Company Health Promotion Initiative members, and potential partners and volunteers.
• Collect and analyze outcomes – Outcomes indicate Company Health Promotion Initiative impact. Begin with just a few outcomes – you don’t have to collect everything. Remember that it’s never too late to start measuring Company Health Promotion Initiative impact.
• Evaluate, improve and re-evaluate – Use participant feedback and Company Health Promotion Initiative outcomes to determine Company Health Promotion Initiative impact. Establish areas in need of improvement. Use outcomes to determine if expended resources were worth the results.