Achieving a Culture of Health

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The Business Case
- A framework to assess the main elements of a health culture
- Tools and techniques for change
- Various roles in creating healthy cultures.

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Achieving a Culture of Health

  1. 1. [Overview] An important strategy for addressing the health- care crisis is to reduce the need for medical services by keeping people healthy. Research shows that as health risks increase, costs increase; as health risks decrease, cost decrease.1,2 Managers and HR professionals offer wellness programs to lower these risks and achieve other benefits (see table below). Typically, these programs include health behavior assessments, education, counseling, campaigns, and incentives — initiatives that encourage employees to become physically active, eat healthier, stop smoking, manage stress, or adopt some other wellness practice. Employees seem motivated: most (80+%) attempt some form of lifestyle improvement annually.3 Unless we keep people from migrating toward new health risks, hoped-for benefits are unlikely to materialize.3 The greatest long-term health-promoting and cost-saving opportunity is to keep low-risk individuals from becoming higher risk. [1] The word [CULTURE] (from the farming concept of cultivation6 ) refers to the social forces that shape behavior and beliefs through mechanisms such as norms, support, modeling, training, rewards, and communication. Strong cultures offer reliable, consistent guidance about attitudes and behavior; weak cultures do not send clear signals. Cultures work at both conscious and unconscious levels, from concrete procedures (like no smoking policies) to subtle influences (like peer group attitudes about exercising during lunch). Workplace culture is a key to profitability, sustainability, and other success measures.7 Making wellness work is well worth it… BENEFIT EXPLANATION Reduce Health Risks Half of all diseases and premature deaths are attributed to unhealthy lifestyle practices such as smoking, physical inactivity, unhealthy diets, and alcohol abuse. Control Healthcare Costs Wellness plays a role in prevention, proper self-care, disease management, and cost-effective use of medical care. Heal Most illness can best be remedied with treatments that include healthier lifestyle practices, stress management, and a positive attitude. Wellness is a part of healing. Deliver Peak Performance Productivity and health are closely linked. Provide Opportunities Helping others is among the best ways to enhance to Assist self-esteem, deepen wellness commitments, and reinforce lifestyle change. Enhance Teamwork/Morale Wellness programs can open new communication channels, break down prejudices, and demonstrate how employees are valued. It’s one more good reason for people to work together. Improve Image Supporting employee and community wellness is a strategy for demonstrating good stewardship, a positive work environment, and corporate citizenship.
  2. 2. [End Notes] 1 Edington, D, Emerging Research – A View From One Research Center, American Journal of Health Promotion, 2001, volume 15:5, pages 341-349. 2 Pronk, N, Goodman, M, O’Connor, P, Martinson, B, Relationship Between Modifiable Health Risks and Short-Term Health Care Charges, Journal of the American Medical Association, 282(23), pages 2235-2239. 3 Edington D, Yen L, Witting P, The Financial Impact of Changes in Personal Health Practices, Journal of Occupational and Environmental Medicine, 1997; 39: pages 1037-1046. 4 Allen, J, Building Supportive Cultural Environments, O’Donnell MP, editor, Health Promotion in the Workplace, Third Edition, Albany, New York: Delmar Publishers, Inc; 2001, pages 202-217. 5 Linman, Laura, Weiner, B, Graham, A, Emmons, K, Manager Beliefs Regarding Worksite Health Promotion: Findings From the Working Healthy Project 2, American Journal of Health Promotion, 2007, volume 21:6, pages 521-528. 6 Merriam-Webster Online Dictionary, Internet Springfield MA: Merriam-Webster, Inc. (cited Dec. 3, 2007); www.webster.com/dictionary/culture. 7 Schein, EH, The Corporate Culture Survival Guide, San Francisco: Jossey-Bass Publishers, 1999. 8 Allen R, Allen J, Certner B, Kraft C, The Organizational Unconscious: How to Create the Corporate Culture You Want and Need, Second Edition, Burlington, Vermont: Human Resources Institute; 1987. 9 Allen, J, Not Alone: Healthy Habits, Helpful Friends, Healthyculture.com Publisher, Burlington, Vermont, 2007. 10 Allen, J, Wellness Mentoring Can Help Rebuild the Corporate Culture, AWHP’s Worksite Health, 1998; Summer: pages 27-30. 11 Allen, RF, Allen J, A Sense of Community, a Shared Vision, and a Positive Culture: Core Enabling Factors in Culture Based Health Promotion Efforts, American Journal of Health Promotion. 1987; 1(3): pages 40 47. 12 Allen, J, Hunnicutt, D, Johnson, J, Fostering Wellness Leadership: A New Model, Special Report from the Wellness Councils of America: Omaha, Nebraska, 1999. This white paper was prepared for Health Enhancement Systems by Judd Robert Allen, PhD, President, Human Resources Institute, LLC. Contact: 802.862.8855, JuddA@healthyculture.com. Additional copies of Achieving a Culture of Health: The Business Case – as well as our white papers Keeping Healthy People Healthy: The Business Case and Employer-Sponsored Weight Management Programs: The Business Case – are available online at www.HealthEnhancementSystems.com or by calling 800.326.2317. Wellness Committees – A Special Culture Change Role Wellness committees can play an important role in health culture planning and follow-through. They should comprise influential people who are passionate about wellness and represent a cross section of employees. Committee members must be capable of: I Seeing all the subcultures I Keeping the culture change effort well organized I Renewing the culture change vision periodically. Outside wellness consultants should be available to guide committee work, conduct objective research, and introduce best practices. Creating a Wellness Culture Together Culture change offers methods for: I Engaging the entire population I Preventing new health risk behaviors I Making it more likely that people will achieve healthy lifestyle goals. The focus is on collective action — how people can work together to achieve wellness. Individual strategies (such as health risk appraisals, online information, wellness coaching, and incentive campaigns) can be combined with culture strategies to achieve higher lifestyle change success rates. The approach that combines individual initiative with ongoing support makes good business sense and is consistent with practices widely appreciated among business leaders and HR professionals. [6]
  3. 3. P H A S E 4 SUSTAINABILITY Evaluate Progress Celebrate Success Renew and Extend [Systematic] Culture Change Culture change is a long-term process that is best achieved systematically.8 In most organizations, 4 phases — carried out over a year or more — make up a practical approach: Health Culture Leadership Executives, managers, supervisors, peer leaders, wellness enthusiasts, and other stake- holders must be empowered to support the wellness initiative for a health culture.12 Training, retreats, and clear communication are important functions in mobilizing effective health culture leaders. Preparation is done primarily through culture surveys, focus interviews, observation, and assignment of leaders (see the next section). Integration emphasizes peer support initiatives and modifi- cation of touch points when new policies, procedures, and programs are implemented. Sustainability involves measuring results, celebrating success, and planning a new round of culture change. Involvement introduces the wellness program vision to employees and gives them an opportunity to set personal goals. LEADERSHIP FUNCTION LEADERSHIP ACTIONS Share the Vision Explain the purposes of the program, why they are enthusiastic about wellness, how employees can participate, and resources that will be available. Serve as Role Models Participate in wellness activities, tell employees how wellness has benefited them personally, and share their own wellness goals. Align Touch Points Address health culture influences (such as rewards, confrontation, and training), give permission to fully use program, and eliminate barriers. Monitor and Celebrate Success Acknowledge individual and group progress (with permission). P H A S E 1 PREPARATION Analyze Set Objectives Develop Leaders P H A S E 2 INVOLVEMENT Introduce the Vision of the New Culture to All Levels P H A S E 3 INTEGRATION Align Cultural Touch Points Primary leadership responsibilities: [5]
  4. 4. [2] Unfortunately, less than 20% of employee lifestyle change efforts reach long-term goals.4 Employees tend to make progress for a few weeks and months only to return to their prior behavior. How do employers meet this challenge? Managers, HR, and wellness professionals are well aware that little of lasting value, including health improvements, can be achieved without a supportive cultural environment. In a recent manager survey5 , only 34% thought information alone would be enough to promote healthy changes. And just 41% agreed employers have a responsibility to encourage employees' healthy lifestyle choices.4 In some organizations, health promotion may be seen as an encroachment on individual responsibility and privacy. Fortunately, a health culture can support positive changes without undermin- ing individual initiative. Most smokers have tried to quit. Almost all overweight people have attempted diets. Most couch potatoes have set goals for physical activity. The objective is to create a workplace where those new positive practices will stick. Adults are most likely to change a health behavior when supported by the people they spend time with, backed by policies and initiatives. With that in mind, this white paper explores understanding and changing workplace culture to support employee health and pro- ductivity, including: I A framework to assess main elements I Tools and techniques for change I Various roles in creating healthy cultures. A[Culture Change] Framework Cultures are complex systems; they're best understood and evaluated by adopting a framework – such as Normative Systems, the subject of more than 50 books and journal articles.8 It identifies 5 primary culture elements: Norms Touch Points Work Climate Peer Support Shared Values/Priorities BEHAVIOR CHOICES [Shared Values/Priorities] Most successful organizations’ cultures value profitability, customer service, and innovation or some variation on those themes. In a health culture, employee well-being also makes the top tier of priorities… embracing the idea that healthy people are essential to overall strategy. Each organization should examine its story and goals for a compelling wellness vision. For example, at Johnson & Johnson the company's history and future are seen as about finding ways to promote health; wellness is embedded in how people think about their employer. In many businesses, personal growth of founders can be communicated to highlight how people achieve their dreams with the support of others. Pulling together to overcome challenges can become a compelling wellness message. Opinion surveys are useful in gauging how highly health promotion is valued. Employees express a range of attitudes toward wellness — from wildly enthusiastic to utterly scornful. Don’t get preoccupied with naysayers; let your health culture soften up this group. Shifting each individual's position closer to wellness champion is the goal. Use the entire wellness value proposition. An employee need not choose among the wellness benefits of containing health cost, raising performance, enhancing morale, or improving the company’s image. Wellness can deliver these benefits and much more.
  5. 5. [Norms] Norms are social expectations for behavior and beliefs — “the way we do things around here” — which become apparent only when they change or someone violates them. (Test this by driving 5 mph below the speed limit. That's likely to result in push-back from other motorists. Though no law is broken, norms have their own enforcement mecha- nisms, as we'll discuss under touch points below.) A wellness culture features norms that make it easier for people to maintain healthy lifestyles — for example, it could be a strong norm to drink water and eat nutritious snacks low in fat, sugar, and salt. Freedom of choice still would be honored because people could bring in their own junk food and soda without being ridiculed. In another health culture example, the norm would be for employees to use their breaks for physical activity, healthy eating, stress management, and friendship; the smoking break would not be the only way to get a time out. TOUCH POINT QUESTIONS TO CONSIDER Modeling • Do leaders and other opinion makers model healthy behavior or something else? • Who could serve as new wellness role models? • How can the visibility of negative models be reduced? Rewards • Are unhealthy practices mistakenly being rewarded or recognized? and Recognition • If someone behaved in healthy ways, would their behavior be acknowledged? Confrontation • Are unhealthy practices mistakenly confronted? • Would there be push-back from the culture if someone behaved in a healthy way? Recruitment • Do those seeking work know this is a health-oriented culture? and Selection • Are new recruits open to and enthusiastic about a wellness lifestyle? Orientation • What is the early experience of employees related to healthy lifestyle choices? • Are new people informed about the wellness program vision and invited to become wellness champions? Training • Are people taught the skills they need to be good at healthy lifestyle practices? • Are people mistakenly being taught how to get by with an unhealthy lifestyle? Rites, Symbols, • Are there special events, daily/monthly activities, and symbolic reminders that wellness is important? and Rituals • Are unhealthy practices such as overeating featured in special events? Communication • Are people given the information they need to make good decisions about wellness? • Are people given regular feedback about personal wellness and wellness within their workgroup? • Do unhealthy practices get all the attention? Relationship • Are work friendships and teams formed during healthy activities? Development • Are work relationships formed around unhealthy practices such as overeating, complaining, and smoking? Resource • Do people have the time, equipment, food, childcare, and other resources needed for a healthy lifestyle? Commitment • Does the use of time, money, and other resources demonstrate a commitment to supporting healthy lifestyle choices? [Touch Points] These touch points are the mechanisms for establishing and maintaining norms. They operate in formal policies, procedures, and programs as well as informal, unwritten social mechanisms. Policies of sticking to a 40-hour work week and taking regular breaks, for example, can be overpowered by praise for going “the extra mile.” Establishing new wellness norms (in general, 2-4 a year) is an important function of a health culture — after surveying to learn perceptions and preferences. Sample priorities include: I Not smoking I Exercising daily I Healthy eating I Getting enough sleep I Focusing on other health behaviors based on organization specifics, such as substance abuse or medical self-care. [3]
  6. 6. Changing cultural norms and touch points requires a deep understanding of the current culture as well as a creative eye for tweaking existing influences. Focus groups with decision makers and a cross section of employees can help identify existing strengths and opportunities for improvement. For example, workers could share the best mechanism to implement a new financial reward program so that it isn’t perceived as a bribe or unfair. These principles are useful in adjusting touch points: I Build on existing strengths by seeing what’s positively influencing behavior now (remember, touch points already function in any culture; the key is to adjust, not replace them — acknowl- edging senior managers have the most power to do this) I Address enough touch points to tip the balance toward wellness — using only 1 or 2 frequently backfires and rarely achieves lasting results I Consult those most affected by touch point changes… often. [Peer Support] In a wellness culture, peer support is assistance from friends, family, cowork- ers, and supervisors to achieve a healthy lifestyle. Wellness programs often include peer support initiatives in the form of 12-step programs, weight control groups, sports teams, recreation events, yoga classes, and running/walking/biking competitions. These activities can be open to employees’ families and friends for even stronger support. Although the support role is being increasingly relegated to external profes- sionals (therapists, wellness counselors, coaches), an effective culture change strategy is to enhance the quality and quantity of informal, internal peer support networks.9 For instance, the Wellness Mentoring10 approach teaches employees how to: I Establish a mentoring relationship I Set goals using the stages of change I Locate effective role models and the right wellness buddies I Eliminate barriers to change I Find or create supportive environments I Work through relapse I Celebrate success. These methods offer numerous benefits for a health culture; they: I Have staying power I Create natural allies and wellness champions throughout the organization I Reinforce self-change skills and raise self-esteem I Are a way to engage others in the employee's support system. [Work Climate] The 3 cultural climate factors described below11 have been found to play important roles in the intersection of organizational development and individual wellness. Where these factors are absent, employ- ees may be so distracted by distrust, anger, and negativity that they can't focus on their own well-being: Sense of Community. Wellness programs can play an important role in fostering a sense of belonging, trust, caring, and mutual understanding in the workplace. Shared Vision. When everyone has a role and a stake in achieving success, the message is clear and inspirational. Wellness programs can support this by being responsive to new initiatives and organization challenges. Example: when a railroad must reduce accidents related to fatigue and substance abuse, the wellness program can respond by bolstering healthier norms for work-life balance, more sleep, and less drinking. Positive Outlook. Workplaces and individuals thrive with optimism and enthusiasm. Wellness programs can encourage a positive outlook through a focus on productive potential, thriving, reaching health milestones, and overcom- ing obstacles. The emphasis is on strengths over weaknesses and investing in productive people over seeing people as risks or a cost of doing business. [4]
  7. 7. How Health Enhancement Systems Products Support a Health Culture A leader in behavior change innovation, Health Enhancement Systems has been developing health improvement solutions for corporations, health plans/systems, hospitals, government agencies, educational institutions, nonprofits, and other groups since 1992. Our specialty is programs that encourage participation in health improvement activities through engaging, inspiring team and individual challenges. Interactive, theme-based campaigns such as Get Fit on Route 66, 10K-A-Day, Colorful Choices, Passport: Round Trip to Health, Great American Fitness Adventure, and NutriSum: Healthy Weight for Life are keys to a health culture; they create a sense of community and dedication to a common goal. Our approach is to have participants reach big goals in order to experience big rewards. We believe behavior change not only requires a supportive environment, but also serious commitment. Employers seeking a health culture will get there only through shared responsibility between the organization and the individual. If you agree, we invite you to review our offerings – visit www.HealthEnhancementSystems.com or call 800.326.2317 (989.839.0852). Copyright © 2008, Health Enhancement Systems. No part of this document may be distributed, reproduced, or posted without written permission from Health Enhancement Systems. Health Enhancement Systems 110 E. Grove Street Midland MI 48640 800.326.2317 www.HealthEnhancementSystems.com

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