Happy, Healthy Employees
What makes for a great employee wellness program? Foremost is putting in place a program that invites participation. Certain key attributes seem to spell success for institutions that have developed popular programs, though interpretation of these attributes may vary based on your employee population.
Convenience. Do you want employees to practice preventive health? Make it easy. Schedule routine screenings on campus for everything from glucose levels and blood pressure to body mass index, and impress upon supervisors that all employees are allowed to take time during their workday to participate.
Variety. Nothing spells doom faster for a wellness program than dull or limited options. Not everyone wants to lift free weights. College and university campuses have a true advantage over other employers in the variety of physical and educational wellness options they can place at the disposal of their employees. In addition to state-of-the art fitness and recreation facilities, many campuses offer unique activities like ballroom dancing and kickboxing as well as swimming, yoga, and racquetball. And nutrition and healthy cooking classes may capture the attention of more employees than you might imagine.
Work/life balance. In addition to a variety of activities, employees appreciate options for when they may participate. Employers that provide release time from work allow more employees to take in a class over their lunch hour. This approach also signals to employees that the institution cares about more than the job at hand. Programs that are fully open to family member participation likewise reinforce the value of work and home/life balance.
Added value. When employees have free or discounted access to special programs or groups, they are more likely to participate in something they otherwise might not join on their own. Many institutions are bringing Weight Watchers groups to campus and offer diabetes prevention and management and smoking cessation classes. For employees with specific health challenges like diabetes, access to counselors who can help them manage their routines can make living with the disease less daunting.
Relevance. To stay motivated, employees need to know they have a say in the changes they would like to see made to the program. In addition to dedicated staff, wellness advisory committees composed of faculty and staff can help ensure that employee input is heard and addressed. This may be as simple as changing the days or times that a particular class is offered to allow more to participate.
Camaraderie. Programming that encourages wide participation also builds relationships among individuals who otherwise might never interact. These friendships not only help to keep employees motivated to remain active and healthy, but they also add to a sense of team spirit and a cross-pollination of ideas that make the institution itself strong and healthy.
Payback. Not all employees are motivated by financial incentives or T-shirt giveaways. Some are inspired by pounds lost or lower health insurance premiums. Whatever the payback, communicating the what's-in-it-for-me can keep employees active in taking care of their health for the long haul.
Review the following mini-case-studies for additional strategies and lessons learned.
RICE UNIVERSITY, Houston, Texas
Details provided by Elaine Britt, director of benefits.
Catalyst: We started our program about six years ago with few resources and a student worker. The tipping point came when we got a new vice president of administration several years ago who really got behind this and became our advocate. We currently contract with a local hospital to provide a wellness coordinator who works on our campus three days each week. Our hope is to extend this arrangement to five days a week and make the position permanent as we continue to expand program offerings.
Key features: We offer health-risk assessments, nutrition and exercise seminars, a full menu of health screenings, and personal wellness coaching. Screenings include everything from blood pressure to cholesterol checks and measurement of body fat index and flexibility. Employees get a comprehensive report including lab results with detailed feedback about areas they might focus on to improve. One special screening that we offer every year is for skin cancer. We bring a dermatologist on site during the summer when employees are more likely to be thinking about their skin. If a particular spot looks suspicious, employees are referred for follow-up testing. This past summer we conducted 255 skin cancer screenings, from which 78 employees were referred for follow-up testing. While that approximately 31-percent referral rate seems high, it's probably also the case that the employees who sought screenings were likely the ones most worried about a particular skin irregularity. We see this as a positive sign in that the convenience of bringing this service to campus means that fewer are putting off seeking assessment and treatment.
In total, we screen approximately 10 percent of employees each year, and we tend to get new people each time. While we don't receive specific data on individual employees, we get an overall profile of our population—for instance, what percentage of our population is overweight or whose cardiovascular health is questionable. Our contractor then looks for those employees with three or more "red flags" and invites them to participate in targeted one-on-one coaching to determine what changes the employee could focus on to mitigate certain health risks.
Another component that has been well received is something we intentionally put in place to reach our employee populations who have less flexible schedules, including custodians and our buildings and grounds crews. A disproportionate health risk we have identified among these employee groups is an increased prevalence of diabetes. In some ways this defies logic, because these employees are typically fairly active throughout the day. The real culprit for them is that their diets tend to be unhealthy. They may be second- or third-shift employees, relying on fast food or snacks from vending machines. In response, our contractor has developed a program to work directly with these managers and to meet with employees to talk about nutrition. As a result of conducting special glucose screenings for these groups, we've been able to identify a number of individuals with high blood sugar levels and have intervened to get them to a doctor right away. Our vendor is now also stocking healthier selections in our vending machines and they have adopted a color-coded system for food choices to indicate healthy (green) items. While this doesn't keep employees from making bad food decisions, it does at least get them to think twice at the point of consumption about what they put in their mouths. We also installed a completely "healthy" vending machine, stocked with wellness-related items, in our new recreation center.
Incentives: We offer Weight Watchers on campus and subsidize 50 percent of the cost for employees. Early on we tried financial incentives of up to $125 per semester for employees who kept journals and accrued points for healthy activities. While this was successful among a small group of employees, most found the journal-keeping too onerous, so now we focus most on providing convenience.
Metrics: Since we are self-funded and directly pay the costs of claims, we aren't in a position to negotiate lower insurance premiums per se. What we are doing is working with our health-care provider to bring benefits in line with what we're trying to accomplish on the wellness side. In July 2008 we initiated a program where for certain diagnoses such as diabetes or high blood pressure, when employees use the pharmacy for a needed medication, they are charged the co-pay upon the first visit. Thereafter, if they use a generic, they get their medications for free (or at half price for name brand drugs). Our ultimate goal is to remove barriers for proven clinical outcomes. For instance, we know that insulin helps diabetics stay healthy and that blood pressure medicine helps people maintain long-term cardiac health. If you remove the cost barrier, people are much more likely to maintain use of their medications. So as an employer, while we've seen our pharmacy costs rise, we're OK with that, because we believe that means that employees are taking their medications and are less likely to some day end up in the emergency room.
We also work to stay on top of the research and apply those findings to what we offer. For instance, there have been many more studies in recent years making the link between good dental hygiene and overall physical health. So now we're trying to encourage more employees to enroll in our dental insurance option and are offering subsidies to our lower-paid employees for dental coverage.
Tips: A real key for us with getting staff participation has been to offer activities at convenient times—but not necessarily during their "free" time. Instead of offering a lot of lunchtime sessions, we now target mornings or afternoons to provide more flexibility. Likewise, because most faculty spend a good portion of their day in classrooms, they are less likely to be attracted to the kind of brown-bag education sessions that other employees may be happy to attend. Another effective practice we've found for getting faculty and staff participation has been to send literature about our program offerings to their homes, since spouses are often key motivating forces.
CALVIN COLLEGE, Grand Rapids, Michigan
Details provided by Henry DeVries, vice president for administration, and Roy Zuidema, director of campus wellness.
Catalyst: While we had some faculty member involvement in health and wellness for about 10 years with some limited wellness programming, the big impetus for us came about six years ago when our health insurance provider approached us and said that if we instituted a wellness program, it would rebate 1 percent of our health insurance premium annually. That amounted to about $50,000 in savings per year. With that incentive from our provider, we moved forward to develop additional programming and dedicate staffing. We also have a wellness committee and about 45 departmental ambassadors from across the campus who serve as cheerleaders to get the message out to fellow employees about what we offer.
As a faith-based institution, we place special emphasis on being good stewards, and that has come to include an understanding about being good stewards of our personal health. To help show our priority, we've woven our commitment to wellness into our mission statement with these words: "We will maintain a workplace that encourages employees to balance the demands of work and personal life," and "We will enhance employee wellness." In this way, employee wellness can be viewed as important as our commitment to campus sustainability.
Key features: Within the past three years we've grown the program from three exercise classes and an annual health challenge to 12 exercise classes, four annual health challenges, 12 to 15 seminars, a monthly newsletter, personal training, an annual 100-mile bike ride, weekly special events, and periodic health screenings. A good example of our success was our "Walk to the Moon" challenge this past year. We gave out pedometers and had employees form teams to encourage each other to stay active during the day. This truly helped change the culture of the college. People continue to get out and walk during their lunch hour or at the end of the day before they go home, and some supervisors and their employees choose to hold their one-on-one meetings while they walk around campus.
Another popular challenge is "Hold it for the Holidays," which is as simple as it sounds. Employees who want to participate put $10 down in advance. They weigh in before Thanksgiving and then again immediately after the New Year. Those who have maintained their weight get to split the cash pool. The amazing thing is that even $10 has the power to motivate. Last year 80 percent of those who participated held to their pre-Thanksgiving weight.
Incentives: We offer a cash incentive of up to $75 per quarter ($300 per year) for employees who complete a minimum of two to four activities each quarter. In addition to physical activity, employees can earn credits in a variety of ways such as getting their flu shot, taking part in a preventive screening, visiting the dentist, giving blood, or attending classes on nutrition or other health-related topics. Additional incentives include t-shirts, iPods, towels, weekend getaways, and so forth.
Tips: Faculty in particular can be a difficult population to engage. One solution is to offer more options outside of the normal work day. When we opened our new fitness facility, we extended the hours from 6 a.m. to 9 p.m. These longer hours of operation also accommodate the needs of second-shift employees. We also leverage students from our various health programs such as physical therapy and exercise science to serve as personal trainers. Every employee can sign up for four free sessions with a student trainer. Finally, the importance of supervisory buy-in can't be overstated. One thing we learned early on is that for hourly employees in particular, granting work release time can mean the difference for their participation. We allow all employees to take 30 minutes of paid time twice each week during their workday to engage in wellness activities. It's a small concession on the part of the employer, but it has to be backed up with supervisory support.
MONTGOMERY COLLEGE, Rockville, Maryland
Details provided by Vivian M. Lawyer, chief human resources officer; Rowena D'Souza, human resources specialist; and Brenda Salas, wellness coordinator.
Catalyst: Several decades ago, a small group of employees started meeting informally to work out together. As the numbers and interest grew, our board of trustees made the decision to formally support a wellness focus by approving policy that offers all employees 1.5 hours of wellness release time combined with other leave each week to participate in wellness activities. That was 20 years ago. About five years ago we dedicated actual staffing for our wellness effort, and the program has since taken off with great success.
Key features: We offer a full range of biometric screenings as well as full access to fitness and recreation facilities, and we place a strong focus on variety of program options and on creative programming. To keep the program fresh, we offer seasonal challenges throughout the year, including "Walktober" each October, "Health for the Holidays" during November and December, "New Year, New Rear" in January and February, "Spring Into Fitness" each April and May, and an "MC to OC" (Montgomery College to Ocean City) beach-themed challenge from June through August. We offer one-on-one wellness consultations with employees and an "ask the nurse" program, and we currently offer 18 traditional group exercise classes each week (body sculpting, spin, Pilates, step, cardio dance, Zumba, body conditioning, and more). We also encourage employees to come forward with suggestions for additional programming and have implemented some of these ideas in our current program, including a joint-exercise for arthritis program twice each week, yoga four times a week, and drop-in basketball three times weekly.
By listening to employees, we've also been able to identify some of the less visible needs and ailments that may be keeping some employees from full productivity. For instance, we have started conducting ergonomic assessments within the workplace to target factors that could be contributing to employee neck and back pain so that we can address these issues proactively before they result in injury.
Incentives: To make participation easier for those whose schedules don't coincide with hours of availability for our fitness facilities, we instituted a program three years ago to allow employees to participate in gyms outside our campus facilities. As long as employees attend a certain number of times each month, their fees are reimbursed by the college through our educational assistance program. We've also extended the wellness program to spouses and retirees to encourage family wellness and lifelong healthy habits.
Tips: While the program has always had high-level support, we are well aware of the fact that within a tight economy, even valuable programs face cuts. We protect this program as much as possible by keeping it within the HR budget as a benefits program. We also are careful in stretching resources as far as possible and are always looking for freebies that we can offer. For instance, when we realized that our faculty and staff assistance program (EAP) provider offered us four free workshops each year, we've since made certain we use these to offer targeted topics such as stress management, smoking cessation, and pandemic planning.
DICKINSON COLLEGE, Carlisle, Pennsylvania
Details provided by John Weis, vice president of human resource services, and Steven Riccio, staff development coordinator.
Catalyst: We launched our wellness program in 2006, essentially from a blank slate. A primary reason for starting a staff development and wellness program was to enhance employee engagement with opportunities to encourage healthy lifestyles and around which employees could build relationships and camaraderie.
Key features: Our Holistic Health Program offerings span four categories of focus: physical wellness, nutrition, preventive health screens, and intellectual wellness. In addition to a range of fitness options and monthly screenings, we offer both stress and diabetes management classes, host on-campus meetings for support groups such as Weight Watchers, and contract with a registered dietician who is available to employees and students for one-on-one nutrition counseling. One unique feature of our program is a focus on professional development—the intellectual component of wellness that we emphasize through various workshops and certificate of completion programs on topics of personal and professional importance for employees. We believe that healthy employees are people who are not only physically fit but who also feel they creatively contribute in their roles to advance the mission of the institution.
Incentives: While some activities require a nominal fee, the college refunds fees in full based on an individual's 75-percent or higher rate of participation. Program participation also allows employees opportunities to earn gift cards of varying amounts based on how intensely they want to participate to accrue points. Engaged employees (100 points) receive a $50 card. In addition to the $50 card, energized employees (150 points) and elite employees (200 points) are eligible to receive a cash prize drawing for gift cards of $250 and $500, respectively.
Metrics: While monitoring the employer-related benefits of offering an employee wellness plan is not a perfect science, we are looking to track some key indicators over time. In addition to measures such as levels of absenteeism, hospital bed stays, and emergency room visits, as best as possible we want to monitor our progress in helping prevent or mitigate chronic conditions such as asthma, diabetes, and cardiovascular disease through screenings and early intervention and education. We are working with local providers to help us establish some baseline metrics.
Tips: We learned early on that you have to listen and respond to what employees want from your program. We made a classic mistake up front by going to great lengths to plan a grand kick-off of our wellness program, complete with a prominent guest speaker, only to have a disappointingly low turnout. The problem was that employees didn't see the value in attending the event. We now have regular focus groups and conduct routine surveys to get employee feedback about what activities are of most interest and importance to them and what best meets their needs in terms of scheduling. This gives us a good framework for making ongoing adjustments. In one instance, we found out that employees didn't like the teaching methods of a particular instructor because too much time was spent reviewing basic techniques in his classes without offering something for those at more advanced levels. This was something very simple that we were able to address right away in efforts to keep employees engaged.
Finally, a primary intent behind any employee wellness program should be to keep people healthy so they don't end up with more serious complications later on. That may mean reviewing the overall structure of your larger health plan and its provisions. Two years ago we adjusted our premiums along a sliding scale based on income. Effective this past July, we made a financial commitment to keep health-care premiums flat for all employees so that they didn't have to pay more in health care at the same time that their earnings remained flat. We were also able to negotiate to hold the line on the cost of renewals on our vision and dental coverage.
NORTH IDAHO COLLEGE, Coeur d'Alene
Details provided by Wade Larson, human resources director.
Catalyst: Last year we implemented a comprehensive consumer-directed health-care program that raised employee deductibles from $200 to $1,000. That alone accounted for a cost savings for the college of $500,000 with no reduction in health benefits for employees. Along with the higher deductibles, the college implemented an aggressive rewards and incentives program for employees engaging in wellness-related activities and healthy behaviors to allow them the opportunity to "earn back" the deductible gap (up to $700) with contributions into their health reimbursement accounts or toward reduced health insurance premiums. Full participation by spouses and family members allow offsets of up to $1,400 annually reimbursed to the employee. (Editor's Note: You can learn much more about the specific structure and cost savings of the North Idaho program in "Share and Share Alike," an article by Larson published in the Fall 2009 CUPA-HR journal, The Higher Education Workplace. Log-in required).
Key features: The aggressive incentives program includes a tiered approach for reimbursing employees with real dollars for specific healthy behaviors. These include monetary payments for completing an annual personal wellness profile and biometrics assessment, completing annual physical and dental exams, and even payment for not using tobacco. In this way, all employees can easily earn at least partial reimbursement for taking part in routine preventive health. A variety of fitness, education, and support-group activities are available on campus or through our community partners.
Metrics: Specific measures are a challenge with regard to health impacts. Where we are best able to track the impact and value of our program is through the organizational report we receive about our employee health risk assessment (personal wellness profile), which employees participating in the plan must complete annually. Over the past two years we have identified momentum toward better nutrition, better fitness, and reduced weight and cholesterol levels.
Tips: Especially where significant financial incentives for participation are involved, you must communicate how employees can maximize reimbursement and why it's in their best interest to do so. Providing context about the costs of health care and how employees directly impact institution costs overall helps them understand their own role more clearly while rewarding them for taking steps that are good for them and for the institution. Reward structures must also be carefully constructed so as not to penalize particular groups. For instance, in our first year of providing reimbursement incentives, we required that employees complete an affidavit that they don't use tobacco in order to participate in the reimbursement program. Unfortunately, that put some employees (smokers) at a full disadvantage. Recognizing that a smoker who goes to the dentist and is physically active is better off than a smoker who does not engage in such activities, we changed the reimbursement structure the following year so as not to fully penalize any employees for what they choose not to do—only for what they choose to do.
Another lesson we've learned is that there are certain behaviors you can't easily motivate. Last year we required fitness activity twice per week and attendance at two wellness sessions each month based on our desire to make education a key component of our program. However, we received more complaints about having to attend the wellness sessions than anything else we've required. So while we still offer these, we no longer mandate attendance in connection with employee reimbursement. One thing you don't want to do is to undermine the success of your program by inadvertently requiring a particular activity that provides a barrier to participation.
Karla Hignite, principal of KH Communication, is editor of NACUBO's HR Horizons. E-mail: karlahignite@msn.com.
