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February 16, 2011
Wellness Prescribed for U.S. Hospitals

Study Recommendations Could Help Your Business, Too

The American Hospital Association (AHA) has issued “a call to action for hospitals to be leaders in creating a culture of health.” To do that, a new report highlights current practices hospitals are using with their own employees and offers how-to recommendations.

The conclusions are of great importance to the healthcare workforce, including nurses, nursing aides, resident doctors, and others who suffer injuries and illnesses due to their employment. It also is applicable to many other businesses that have decided to make 2011 the year they finally begin to focus on employee wellness.

More than a good idea, a health and wellness focus is good business. Many employers report a return on investment (ROI) of $3 and more per dollar invested. The payback comes from increased productivity and fewer and lower-dollar insurance claims.

What’s Happening In Hospitals Today

About a year ago, the AHA’s long-range planning committee started to gather information from 876 hospitals about current programs and experiences. Here’s what they learned:

  • A range of programs are being offered such as tobacco-free campuses, health risk assessments (HRAs), WeightWatchers and other weight-loss programs, discounted gym memberships, updated cafeteria menus, and altered premium discounts based on employee participation.
  • Little ROI data have been compiled and most programs are less than 3 years old.
  • Engaging all employees in health and wellness (high-risk people as well as the “gym rats”) is a challenge.
  • Leadership commitment that demonstrates commitment and encourages staff participation is critical to success.
  • Moving toward a “culture of health” and population health management, rather than a program-by-program approach, is essential.

AHA found that while most hospitals have wellness programs, there is a wide variety of offerings. Most institutions offer HRAs, but more intensive and individualized activities—such as personal health coaching and a 24-hour nurse hotline—are rare. The results also found that employee participation levels in wellness programs could be improved at most hospitals.

One of the key motivators for hospitals to improve their wellness initiatives is to provide an example of commitment to the community. And one of the biggest challenges identified is to motivate employees to participate over time. Most incentives are based on participation rather than program completion or outcomes. While many use measures of success like the overall number of participants, fewer use outcome measures such as improved cholesterol levels.

Recommendations And Action Steps

Based on survey results and best practices, AHA has published seven recommendations for wellness programs and suggested action steps to achieve them.

1. To serve as a role model of heath for the community. This can be done by working with local employers to build an integrated, regional approach that shares risks and rewards. For example, hospitals can offer health and wellness program benefits to all employee dependents.

2. Create a culture of healthy living. Successful wellness program are integrated into an organization’s business strategy. Strategies include removing “environmental inconsistencies” such as unhealthy foods at meetings or in cafeterias. Commitment should start at the top—health and wellness indicators can be included in corporate dashboards, and CEO compensation can be linked to meeting health objectives.

3. Provide a variety of program offerings. AHA recommends that all hospital wellness programs require a health risk assessment and biometric screening. These become more valuable if they are followed up by effective health coaching and participation in programs. All hospitals can have smoke-free campuses and are encouraged to make smoking cessation mandatory for all smokers. Wellness offerings should be reevaluated annually and adjusted to meet changing needs.

4. Provide positive and negative incentives. AHA says both are effective in improving participation levels. Financial incentives have been strongly linked to program participation. Hospitals can also experiment with various types of incentives and measure their effect. Inexperienced hospitals can start with positive incentives and, if necessary, move to negative ones to increase participation. The association found that three out of four hospitals do not offer more than $300 in annual incentives.

5. Track participation and outcomes. The survey found wide variation in the percentage of employees participating in programs, as well as a variety of participation and outcome measures. Hospitals new to wellness can first focus on measuring and increasing participation levels. Participation can be tracked by assessing the number of overall participants and those who complete an HRA, exercise regularly, enroll in a quit-smoking program, or who enroll in a diabetes management program. Once participation targets are achieved, advance to tracking outcomes, AHA suggests.

6. Measure for return on investment. To achieve ROI, hospitals must first commit to effectively measure it over several years. Although many employers have struggled with this metric, those that have measured ROI have had positive results. One solution is to start off small by measuring ROI for a subset of wellness activities. Then build on this success to gain an organizational commitment to measuring the return for all wellness activities. Measure healthcare cost savings and savings related to improvements in productivity—so called “hard” and “soft” numbers.

7. Focus on sustainability. The final recommendation addresses two big challenges to health and wellness programs—motivating employees over time and managing financial constraints that inhibit sustainability. Getting better ROI data, providing more and different types of incentives, and providing new programs can help overcome those challenges. The key, says AHA, is to approach health and wellness as a constant, not as an annual event. Communications from leadership should emphasize that health promotion is a long-term priority. If implementing a full program is not possible, start small and build on that success.

Findings Apply Widely

AHA chairman John Bluford believes that the findings are applicable to employers in nonhealthcare settings as well. Bluford, who is also president and CEO of Truman Medical Centers in Kansas City, Missouri, says employers in all industries must make wellness a value.

“It can’t be the program of the week. It’s got to be woven into the culture of our organization.” For Bluford, that means wellness has to move from top down and from bottom up. Leaders need to be committed and engaged—they have to watch what they eat at the company cafeteria and integrate health and wellness into their benefit design.

“Healthcare professionals have a moral and professional responsibility to be healthy, well, and fit. We’ve got to walk the walk.”

He stresses the importance of communities and employers working together toward better health for everyone in the community. He also favors employer partnerships with insurers and food service vendors.

Asked if economy-related cutbacks make it harder to establish and maintain health and wellness programs, Bluford says No. “Data show that for each $1 spent on health and wellness, companies are seeing about $3.25.” They’re also saving considerably on losses related to absenteeism and presenteeism (being present, but not fully productive).

Bluford is impressed with the number of forward-looking organizations whose best practices were highlighted by the AHA report. He anticipates continued focus by employers growing into a “national movement” around health and wellness improvement.

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