The most effective way to screen is to utilize a health professional trained in wellness screening techniques and counseling to privately and individually assess participants. This wellness professional takes a brief health history and measures Blood Pressure (BP) and cholesterol. With computerized cholesterol desktop analyzers, results are obtained in about four minutes.

Immediate feedback, consultation, and educational materials are given. For those identified at-risk, follow-up appointments can be scheduled at this time. The whole process takes about twenty minutes per individual. The screening also provides an immediate opportunity to register participants in various health improvement programs based on their interests and identified health risks.

Health assessment can be done on an annual basis and used as a means of monitoring health risks within the worksite.

A health evaluation program needs to support multiple opportunities for participation. The service should be provided for all the various shifts of a organization. The evaluation program should be conducted in highly visible areas so the process can be inspected.

Reluctant staff members frequently like to be able to see what the program is about before they participate. When wellness screeners are not busy, they should perform outreach going to areas where staff members gather and attempt to recruit staff members.

When well-planned and promoted, health screening can attract participation rates of 60 percent to 100 percent. These high participation rates have a positive impact on management producing reinforcement for further programming.

Objectives are specific and provide a means of measurement of the program to determine performance. There are two types of objectives, process and outcome. Process objectives state the activities that need to occur to achieve a desired outcome.

Examples of process objectives are:
• Number of participants screened
• Number of participants in and completing health improvement programs
• Satisfaction of program participants
• Number of participants who were medically referred and saw their physician
• Number of promotional activities
• Number of participants seen in follow-up

Example of outcome objectives are:
• Number of participants who improved fitness level
• Number of participants who lowered cholesterol level
• Number of participants who lost weight, body fat
• Number of participants who quit smoking
• Number of participants with elevated Blood Pressure who lowered their Blood Pressure
• Number of participants whose initial level of alcohol consumption put them at-risk who are no longer at-risk
• Number of participants with risk factors who saw their physician and are being treated for high Blood Pressure (BP) or cholesterol years later

A common mistake is filling the Employee Health Promotion Program Committee with the most health/fitness-conscious people in the corporation. Don’t rely solely on volunteers to fill a Employee Health Promotion Program Committee. Make sure that your Employee Health Promotion Program Committee members have enough authority in the corporation to run an effective wellness program.

The Employee Wellness Program Committee is made up of staff members from the workplace. It oversees the wellness program and helps carry it out. The Employee Wellness Program Committee ought to meet about once a month to review the previous month’s activities and plan future ones. When the program is just starting, the Employee Wellness Program Committee may meet on a weekly basis until things get going.

Committee participants do not carry out medical care procedures, counsel clients, or handle confidential health information. Wellness professionals perform these tasks.

In general, the Worksite Wellness Program Committee’s duties fall into three areas: planning, promoting, and assisting to run programs.

Beginning the programs can include:

• Finding space for activities
• Developing and organizing worksite-wide programs such as contests
• Analyzing reports prepared by the program employee and making recommendations

Promoting the program can include:
• Recruiting workers to take part in assessment and health improvement programs
• Encouraging employees to take part in follow-up counseling
• Organizing promotional strategies using newsletters, signs, bulletin boards, computers, and other media available within the workplace

Helping to run the program can include:
• Setting up equipment for various activities
• Helping to conduct worksite-wide activities
• Monitoring all activities and reviewing the effectiveness of the professional employee
• Acting as wellness mentors to fellow employees

The size of the Workplace Wellness Program Committee will be dependent on the size of the business. Pick members by asking day management to nominate or appoint workers.

Make an announcement through brochures, memos, and meetings to recruit potential participants. Explain the purpose of the Employee Wellness Program Committee, duties and responsibilities, and the time responsibility.

Recognize your Company Wellness Program Committee volunteers. Allow them to participate in programs at a reduced cost. Hold appreciation breakfasts/lunches/dinners. Print names of Company Wellness Program Committee participants on corporation communications about the wellness program.

Purchase special T-shirts, caps, and buttons for them. Write letters to supervisors saying that you appreciate the member’s service. Develop awards certificates for participants.

The following can be used as a guide for Worksite Health Promotion Program Committee size:

• Less than 300 employees   2 to 4
• 300 to 1,000 staff members   4 to 6
• 1,000 workers or more   6 to 12

It includes peer backing from family, friends, and co-workers. This backing can help one adopt healthy lifestyles. Tools are available to audit a company.

The long-term success of any wellness program is dependent on the corporate culture.

Some healthy culture signs in a organization are:

• staff members communicate openly
• Leaders support diversity and opinion
• workers have fun
• Policies support wellness
• staff members are encouraged to grow
• staff members work together as a group
• employees’ skills and talents are matched to their jobs.
• Flexible work schedules are available
• Employers consider workers as their most important asset

People have a sense of community, a shared vision, and a positive outlook. Policies promote and support wellness efforts within the workplace.

• Effective programs identify ways that employer policies and employer traditions encourage wellness.
• Effective programs work at the group and corporation level to build support for healthy lifestyle choices.
• Effective programs set clear target objectives for the health improvement of the workplace.

• Ask mostly closed-choice questions, especially if you will be sending the survey to a big number of staff members. Closed-choice questions provide specific choices and are easy to tabulate. You may want to use a computer for data entry and analysis.
• Invite comments, suggestions and recommendations, or ask open-ended questions at the end of the survey. Open-ended items are more difficult to summarize.
• Include a brief explanatory cover letter with the survey with the signature of the company president. Make sure to include a statement about confidentiality and anonymity.
• Ask a group of representative employees to review the survey before it is distributed. Find out if the questions will be understood by employees and will not be objected to.
• Include demographic information at the beginning or end of the survey. Consider various ways that you might analyze the responses by demographic characteristics (gender, age, shift, site, department, etc.).

When considering who must get the survey, a simple rule is if you have under 500 staff members, everyone must receive one. The public relations benefit of everyone receiving a survey can be valuable. Over 500 staff members, a sample of the work population will suffice. A sample saves on costs and time. You may want to consider consulting with a statistician to determine the right sample size for your worksite.

Needs surveys are confidential and anonymous; they do not request information that may identify a person.

Getting backing from management is crucial to the success of the program.

One way to do this is to survey managers (see forms) and conduct interviews with decision-makers in the organization. You can use the surveys here or make up your own. If you decide to do your own, keep the survey short. It shouldn’t take more than ten minutes to complete.

The interview process can also serve as a means of educating management. Give concise fact sheets on the advantages of wellness programs for management. When surveys and interviews are completed, tally the surveys and write brief summaries of the interviews. Give these reports to management.

Once completed present a brief executive summary to management. Highlight a few interesting findings that can be used immediately to make decisions about the program.

Utilize charts and graphs to make your points. Prepare a detailed report for Corporate Wellness Program Committee members itemizing each response. Provide a short article about the survey in the employer newsletter.

The higher the response the more valid and reliable the results. A minimum response of 40 percent to 50 percent is acceptable.

Developing all-inclusive Worksite Health Promotion Programs involve performing a needs and interest assessment, appointing a Worksite Health Promotion Program Committee, selecting wellness providers, setting goals and objectives for the corporate wellness program, marketing/promoting the program, and instituting procedures to ensure confidentiality.

Implementation of accross the board Employee Wellness Programs consist of five major tasks:

1.   Health screening and referral
2.   Follow-up and counseling staff members
3.   Follow-up with physicians
4.   Health improvement programs
5.   Organizing worksite-wide activities.

Evaluation involves monitoring Workplace Wellness Programs to find out if it is working and to help you refine it. Measuring success shows what you have achieved, helps justify expenditures, and provides information for management to support continued programming.

Health risks increase costs.  Healthcare Insurance costs escalate with both age and number of risks present.8,10   The number of risks is also strongly related to sick leave absenteeism, Worker’s Compensation costs, short-term disability, and reduced productivity (”presenteeism”).

Early Corporate Health Promotion Programs were relatively basic and typically produced a return on investment (ROI) of less than one dollar for every dollar invested operating the program (ROI = <1:1).8 Such programs might be characterized as "fun-oriented".  Participation is entirely voluntary, and there is no particular focus on the reduction of specifically identified high risks.  Interventions and activities are not personalized, and there is no emphasis on the management of health expenditures.  These programs are typically site-based only, lack options to address all of the primary behaviorally-related health risks, and lack multimodal presentation.  Minimal or no incentives are offered to employees for participation, and services to spouses and family members are not available.  Most such programs lack meaningful evaluation.  

More conventional programs are "activity-oriented" and have shown an ROI of between 1:2.5 and 1:3.5.8 These programs may have a greater emphasis on health and risk reduction, even though the efforts are relatively broad and not customized.  They may have some generalized emphasis on health cost management, even though not necessarily aimed at specific high risks.  Most are site-based and voluntary, with spouses included only rarely.  Modest incentives may be utilized to advocate participation.  Formal evaluation may be weak.

The newest and most economically viable programs are "results-oriented" and exemplify the health and productivity management model.  These programs consistently produce return rates of 1:4 or greater within a 12-24 month period.8   Such programs are strongly focused on the reduction of specifically identified high risks and the management of health expenditures.  They are generally voluntary, but use strong monetary and other incentives and rewards to reward participation.  They are multi-component in nature (address all major risks), and have both workplace and virtual modalities of operation.  The interventions are highly targeted and individualized, and offered to spouses as well as workers.

For employers, the expense of providing health insurance for their employees is of great importance.  Those costs have been rising at yearly rates between 6% and 14%. Chapman's 2007 systematic review published an average decline in medical costs of 26.5% as a result of Employee Wellness Programs.  His review covered 60 of the most scientifically valid studies, with an average of 3.77 years of study.

Absenteeism due to illness is another cost driver.  Chapman's review reports an average decline in sick time of 25.3%.   Cost for Worker's Compensation was reduced by 40.7%, and disability costs by 24.2%. There is also an emerging literature on the costs of presenteeism (reduced productivity).11,13  In one study, every risk reduced through a wellness program yielded a 9 percent decline in presenteeism (and a 2 percent decline in absenteeism).

Some employers have achieved a zero percent rise in health care costs across at least brief periods of time.10  Doing so requires 90-95% participation of the employee population in focused wellness drives, with 75%-85% of the staff members falling into the low risk category.10  Although robust efforts to reduce the risk status of those in moderate or elevated risk categories must be made, the needs of currently healthy staff members must be addressed as well to avoid increases in risk-status.

Given the size of the federal workforce, significant cost savings in the government's contribution to medical insurance premiums for staff members could be achieved if a majority of that population were participating in active wellness programs.  Similarly, improvements in absenteeism, worker's compensation, disability, presenteeism, and turnover as a result of robust Corporate Health Promotion Programs would provide substantial fiscal advantages for the government.

References

1.   Aldana, Steven G.  (2001)   Financial Impact of Employee Health Promotion Programs:  A Comprehensive Review of the Literature.   Am J Health Promotion 15(5):296-320.
2.   Chapman, Larry.  (1998)   The Role of Incentives in Health Promotion.  The Art of Health Promotion  2(3):1-8.
3.   Chapman, Larry.   (2003)   Biometric Screening in Health Promotion:  Is it Really As Important as We Think?  The Art of Health Promotion  7(2):1-12.
4.   Chapman, Larry.  (2005)   Meta-Evaluation of Worksite Health Promotion Programs Economic Return Studies: 2005 Update.  The Art of Health Promotion, July/August, 1-15.
5.   Chapman, Larry.   (2006)   Employee Participation in Corporate Wellness Programs and Corporate Wellness Programs:  How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6):  431-432.
6.   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   The Role of Health and Wellness Coaching in Company Health Promotion Programs.   The Art of Health Promotion, July/August, 1-12.
7.   Chapman, Larry.  (2007)   Proof Positive:  An Analysis of the cost-Effectiveness of Job Site Wellness.  Northwest Health Management Publishing, Seattle, WA.
8.   Chapman, Larry.  (2007)   An In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
9.   Edington, Dee.   (2001)   Emerging Research:  A View from One Research Center.  American Journal of Health Promotion 15(5): 341-349.
10.   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
11.   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Work Productivity.   Journal of Occupational and Environmental Medicine, 46(7): 746-754.
12.   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of comprehensive Health and Disease Management Programs at the Worksite: Update VI 2000-2004.  JOEM 47(10)1051-1058.
13.   DeVol, Ross, Bedroussian, Armen, et. al.  (2007)  An Unhealthy America:  The Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.
14.   Partnership for Prevention.  (2008) Investing in Health:  Proven Health Promotion Practices for Workplaces.   http://www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.

The more recent literature reflects improvements in wellness programming along with greater return on investment (ROI).  In general, the more focused and intensive the program, the greater advance realized.  To enhance their effectiveness federal government Company Health Promotion Programs may be able to incorporate some of the features described.  Employee wellness programs established to have positive returns on investment frequently include the following features:

1.   Health and work rate management model
Programs characterized by this model focus attention on identification and reduction of specific risks or behaviors such as smoking, lack of physical activity, excess weight, unhealthy diet, high blood lipids, high Blood Pressure, stress, depression, and so on.  High-risk employees are specifically targeted for intervention, although the most efficacious programs also direct efforts towards healthy employees in order to maintain their low-risk status.  This model emphasizes outcomes as opposed to simply offering wellness activities for their own sake.  

2.   Health risk appraisal
Use of a computerized health risk appraisal (HRA) instrument with individualized feedback and recommendations is almost universal in thriving programs.  Staff Members take the questionnaire annually in many cases.  The HRA serves to expand awareness, offer direction, and motivate individuals to better specific behaviors.  In some cases, the personalized report is directly linked to appropriate resources related to identified risks.  Research indicates that the use of an HRA is effective if it is followed by some kind of educational or therapeutic intervention for identified risks.  It frequently serves as the entry point into wellness programs.

3.   Biometric Testing
Many programs combine the results of the health risk appraisal with measurement of each employee’s biometrics, including weight and Body Mass Index (BMI), Blood Pressure (BP), cholesterol, fasting glucose, and assorted other metrics.  Combining the results of the HRA with biological measures results in a more accurate risk profile.   Computer health risk appraisals frequently incorporate biometric data in their risk analysis.

4.   Incentives
employees are usually given monetary or other significant rewards for completing an HRA, participation in a program or class, specific accomplishments such as stopping smoking, losing weight, or working out, and for maintaining healthy status and/or behaviors.  In numerous cases the monetary incentives are associated with reductions in health care insurance premiums.  Some programs use disincentives as well as incentives, such as charging employees who use tobacco higher rates for their health care insurance contribution.

5.   High participation rates
Successful programs use incentives to drive participation rates up.  They also market their programs extensively, and may use contest or challenge strategies to heighten enthusiasm and encourage participation.

6.   Wellness coaching
staff members with identified risks or desire to improve their health habits may be periodically coached via phone by trained health & wellness coaches.  Health and Wellness Coaching helps staff members set and achieve realistic lifestyle-related objectives and goals including those addressing stress, work life balance, smoking, weight, physical exercise, and various behavior modifications.  Three or more sessions are generally available.  In some intensive programs, the coaching extends to actual disease management intervention for staff members with identified elevated-risk diseases.

7.   Multiple formats
Programs may offer wellness content in internet based, paper, and seminar formats to support stimulating variety and alternatives in order to accommodate the needs of all employees.  In addition to on-Site physical exercise and healthy eating activities, on-line programs, e-mail reminders and notices, printed newsletters and materials, and business sessions are common dissemination strategies.

8.   Upper Management backing
Enthusiastic and persistent endorsement by management is vital to achieving high rates of participation.  When senior executives are wellness role models themselves the effects of endorsement are enhanced.

9.   Frequent contact
Effective programs have common contact of some sort with every employee.  This may be through marketing efforts (e.g., posters, e-mail notices, reminders, or messages, etc.), bulletin boards, newsletters, employee meeting presentations, discussion in new employee orientation, supervisory sessions, etc.   The key is to enhance employee awareness of wellbeing and health opportunities and reinforce the corporate emphasis on wellness through common and multiple “touches”.

10.   Open enrollment
To bolster high participation rates staff members must have simple access to the wellness programs and activities.  Open and uncomplicated enrollment processes achieve this.  Some companies automatically enroll all staff members and then allow those who do not wish to take part to “opt-out”.  This practice has been demonstrated to boost enrollment rates in some settings.

11.   Family involvement
Many programs promote spouses and other family members to take part in the organization wellness activities and to adopt a healthy lifestyle along with the designated employee.  It is far easier for the employee to have a healthy lifestyle if his/her family does so as well.

12.   Smoking cessation
Because smoking and other tobacco use is the number one threat to health it is vital to offer workers effective and convenient assistance with stopping.  Access to tobacco cessation pharmaceuticals is frequently part of such programs.  In-house programs provide the most convenient access to these services, although on-line or phone-based programs may be available as well.  

13.   Exercise
Regular physical activity is a core component of every wellness program.  Employees must be strongly encouraged to engage in regular physical activity.  Most programs provide either periodic or continuous worksite opportunities, and some locations have worksite gyms, swimming pools, walking trails, etc.  Discounted or paid memberships to neighborhood exercise facilities is a common alternative to worksite facilities.

14.   Weight management
Because obesity is a major threat to health it is imperative that programs offer effective assistance with weight management.  Enthusiastic encouragement from management to shed excess weight is valuable.  Internet based programs, workplace programs, or discounted access to weight management programs in the area may all be available.  Long-term follow-up is critical for maintenance of weight loss.

15.   Stress management
Workplace stress is perhaps the most common objection among staff members and a primary contributor to absenteeism, presenteeism (reduced productivity), and low morale.  Almost all successful wellness programs offer assistance with personal and workplace stress.  Some programs refer staff members to outside resources for more serious conditions like depression and anxiety disorders, but most offer internet based or frequent workplace general stress reduction programs.  Some organizations endeavor to structure the work environment to minimize stress, both physically and operationally.

16.   Health screenings/immunizations
workers are actively encouraged to complete recommended medical care screenings for Blood Pressure, cholesterol, BMI, colorectal and breast cancer, and others.  Annual influenza immunizations are also encouraged.  Some sites offer these services at the worksite.  Incentives are frequently awarded for completion of these screenings/immunizations.

17.   Onsite medical care
Actual provision of onsite primary care medical services is a growing trend.  The rapidly escalating costs of medical care insurance for staff members has stimulated this trend.  Some businesses have found that it is less expensive to support primary care services themselves than to fund those services through health insurance.  Onsite care also reduces the amount of time staff members would otherwise spend away from the worksite getting such services.

References

1.   Aldana, Steven G.  (2001)   Financial Impact of Employee Health Promotion Programs:  A Comprehensive Review of the Literature.   Am J Health Promotion 15(5):296-320.
2.   Chapman, Larry.  (1998)   The Role of Incentives in Health Promotion.  The Art of Health Promotion  2(3):1-8.
3.   Chapman, Larry.   (2003)   Biometric Screening in Health Promotion:  Is it Really As Important as We Think?  The Art of Health Promotion  7(2):1-12.
4.   Chapman, Larry.  (2005)   Meta-Evaluation of Worksite Health Promotion Programs Economic Return Studies: 2005 Update.  The Art of Health Promotion, July/August, 1-15.
5.   Chapman, Larry.   (2006)   Employee Participation in Corporate Health Promotion Programs and Corporate Health Promotion Programs:  How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6):  431-432.
6.   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   The Role of Health and Wellness Coaching in Employee Health Promotion Programs.   The Art of Health Promotion, July/August, 1-12.
7.   Chapman, Larry.  (2007)   Proof Positive:  An Analysis of the cost-Effectiveness of Job Site Wellness.  Northwest Health Management Publishing, Seattle, WA.
8.   Chapman, Larry.  (2007)   An In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
9.   Edington, Dee.   (2001)   Emerging Research:  A View from One Research Center.  American Journal of Health Promotion 15(5): 341-349.
10.   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
11.   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Work Productivity.   Journal of Occupational and Environmental Medicine, 46(7): 746-754.
12.   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of comprehensive Health and Disease Management Programs at the Worksite: Update VI 2000-2004.  JOEM 47(10)1051-1058.
13.   DeVol, Ross, Bedroussian, Armen, et. al.  (2007)  An Unhealthy America:  The Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.
14.   Partnership for Prevention.  (2008) Investing in Health:  Proven Health Promotion Practices for Workplaces.   http://www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.

Evaluations may conclude that some interventions didn’t work well. You may discover that a popular Employee Health Promotion Program expenditures too much and didn’t really affect employees’ health. While these may not be the outcomes you hoped for, without this information you might continue ineffective interventions. Having this information will help you foster better solutions. When your results are great, it’s magnificent! You can spread the word to workers and management that your program is achieving its goals and objectives.

Three primary areas of an assessment

• Workplace Wellness Program structure – The basic framework of the program
• Workplace Wellness Program process – How well the program is run
• Company Wellness Program outcomes – Whether the program met the set objectives

Common questions used to evaluate a Employee Wellness Program

Company Wellness Program Structure Questions

• What is included in the Corporate Wellness Program? What is the intervention?
• Where does the Corporate Health Promotion Program take place?
• How is the Employee Health Promotion Program delivered? What content is included?
• Who manages the Corporate Health Promotion Program?

Company Wellness Program Process Questions

• How many people participate?
• Do participants complete the Employee Wellness Program?
• Are participants satisfied?
• Which aspects of the Corporate Wellness Program are best attended?

Workplace Health Promotion Program Outcome Questions

• Does the Workplace Wellness Program improve knowledge about health problems?
• Does the Workplace Health Promotion Program modify behavior?
• Does the Company Wellness Program save the corporation money?
• What is the return on investment (ROI)?

• Determine through an employee survey what incentives and rewards they value.
• Identify what incentives and rewards the business can support as well as what the budget will allow.
• Make sure that every colleague who achieves a objective receives some recognition.
• Avoid offering rewards and incentives for the “best” or the “most.”
• Avoid using food as a reward.
• Use incentives/rewards to promote your Corporate Wellness Program, through logos and branding.