The Evidence and Science Ken Holtyn Holtyn & Associates, LLC
BEST PRACTICE RESEARCH WHAT WORKS University of Michigan Researchers: John C. Erfurt, Andrea Foote, Max A. Heirich, Ken Holtyn Began research interventions 1977 Implemented in over 100 worksites Small, Medium, Large worksites White & Blue Collar Reached over 100,000 people Participation rates 75% or more CVD Risk Reduction 50% or more
Worker Health Program, Institute of Labor and Industrial Relations, The University of Michigan, Ann Arbor 48109. BACKGROUND. Worksite wellness programs vary considerably in their design. This study tested four models to compare effectiveness at controlling high blood pressure, obesity, and cigarette smoking. METHODS. Baseline screening was conducted in four manufacturing plants. Site 1 offered screening only, with referral recommendations for those found to have CVD risks. Site 2 also provided health education information and classes. Site 3 added routine follow-up counseling and a menu of intervention types, and Site 4 added social organization within the plant. Random samples of 400 to 500 employees were rescreened at the end of three years. RESULTS. Major improvements in risk levels were found with the addition of routine follow-up counseling and a menu of interventions (Sites 3 and 4, compared with Sites 1 and 2). More hypertensives entered treatment and showed greater reductions in blood pressure. Participation in worksite weight loss and smoking cessation programs was significantly increased, and those who participated showed significantly better maintenance of improvements where follow-up was provided. DISCUSSION. The program models that offered short-term interventions promoted through local media suffered in comparison with models that included personal outreach to people at risk, a variety of health improvement intervention modalities, and ongoing follow-up counseling to help people make decisions and sustain health improvements. Publication Types: Clinical Trial Multicenter Study Am J Health Promot. 1991 Jul-Aug;5(6):438-48 PMID: 10148672 [PubMed - indexed for MEDLINE]
Erfurt JC, Holtyn K. Institute of Labor & Industrial Relations, University of Michigan, Ann Arbor 48109-2054. Wellness programs were tested in three sites, representing three different types of small businesses. The sites ranged in size from 296 to 5 employees. The program at each site included: 1) wellness screening, 2) referral to community physicians for high blood pressure or cholesterol, 3) on-site wellness programs, and 4) long-term follow-up counseling. At sites 2 and 3, the respective company paid the full cost of these services; at site 1, the companys financial support was limited to 50% of the cost of screening. Results showed that participation in screening was severely reduced in the third company, and participation in follow-up and wellness programs dropped to zero. In contrast, there was full participation in all facets of the program at the two sites that paid all costs. Twelve-month follow-up data showed improvements in blood pressure, cholesterol, cigarette smoking, weight control, and oxygen uptake. J Occup Med. 1991 Jan;33(1):66-73 PMID: 1995805 [PubMed - indexed for MEDLINE]
Heirich M, Sieck CJ. University of Michigan Worker Health Program, Ann Arbor 48109, USA. This study addresses the question of worksites as an effective route to alcohol abuse prevention. Hypotheses tested include: (1) Cardiovascular disease risk reduction programs provide effective access for alcohol behavior change. (2) Proactive outreach and follow-up have more impact on health behavior change than health education classes. (3) Ongoing follow-up counseling produces the most behavior change. (4) Screening alone produces little change. The study population included 2000 employees, recruited through cardiovascular disease health screening, who were randomly assigned to individual outreach or classes interventions. Changes in the organization of work required more visible outreach, which produced demands for counseling services from many employees who were not in the original group targeted for outreach. After 3 years of intervention, rescreening results strongly supported hypotheses 1 and 2. Spill-over effects from counseling produced plant-wide improvements, so that hypotheses 3 and 4 were not confirmed. This demonstrates that highly visible outreach provides a cost-effective strategy for cardiovascular disease and alcohol prevention. Publication Types: Clinical Trial Randomized Controlled Trial J Occup Environ Med. 2000 Jan;42(1):47-56 PMID: 10652688 [PubMed - indexed for MEDLINE]
Screened for CVD risk factors, educated and individually counseled 275,000 small business employees. Implemented in over 12,000 small business worksites where majorities of Michiganians are employed. Identified 36% of participants to be at high risk for CVD Achieved a 73% successful medical referral rate Achieved 53% CVD risk reductions 98% high approval rating by participating worksites 97% would recommend program to other companies 200 approved wellness vendors
Improved employee morale 73% Improved employee health 72% Increased productivity 51% Decreased absenteeism 51% Decreased health care costs 41%MDCH Worksite Community Health Promotion Program 2000
Small firms: • Represent 99.7 percent of all employer firms. • Employ half of all private sector employees. • Pay 44 percent of total U.S. private payroll. • Generated 65 percent of net new jobs over the past 17 years. • Create more than half of the nonfarm private GDP. • Hire 43 percent of high tech workers ( scientists, engineers, computer programmers, and others). • Are 52 percent home-based and 2 percent franchises. • Made up 97.5 percent of all identified exporters and produced 31 percent of export value in FY 2008. • Produce 13 times more patents per employee than large patenting firms. Source: U.S. Dept. of Commerce, Census Bureau and Intl. Trade Admin.; Advocacy-funded research by Kathryn Kobe, 2007 (www.sba.gov/advo/research/rs299.pdf) and CHI Research, 2003 (www.sba.gov/advo/research/rs225.pdf);U.S. Dept. of Labor, Bureau of Labor Statistics.
Decision to implement made quickly Ease of program communication Significant health outcomes achieved quickly, as little as 3 months Strong loyalty created High participation, 70% - 100% Family atmosphere Supportive culture created rapidly
Mercers 2010 national survey of 2,800 company employer-sponsored wellness plans, 27% of small business report doing wellness activities 2004 National Worksite Health Promotion Survey. They examined a national cross-section of worksite wellness programs. The results showed that only 6.9% of American worksites offered comprehensive programs. Only 8% of small worksites offered any wellness activities.
1. Employ features and incentives that are consistent with theorganization’s core mission, goals, operations, and administrativestructures.2. Operate at multiple levels, simultaneously addressingindividual, environmental, policy, and cultural factors inthe organization.3. Target the most important health-care issues among theemployee population.4. Engage and tailor diverse components to the unique needsand concerns of individuals.5. Achieve high rates of engagement and participation, both inthe short and long term, in a defined “core program.”6. Achieve successful health outcomes, cost savings, andadditional organizational objectives.7. Are evaluated based upon clear definitions of success, asreflected in scorecards and metrics agreed upon by all relevantconstituencies.*Advisory Panel for the Centers for Disease Control and Prevention and the Chronic DiseaseDirectors Association, Worksite Health and Productivity Management Project, March 2005.
Works to measurably improve the culture and environment of worksite Something for everyone Gives choices - individual coaching, small group, classes, internet programs offered. Periodic evaluation of its results Program emphasizes follow-up Program offers support for the employee as long as he/she is employed. Research Studies have shown this approach to be highly successful.
Biometrics (with actual fitness measurement via polar fitness test) percent fat measurement ◦ Initially 4 x per year with one CVD risk (70-80% of employees) ◦ Second and subsequent years 2 x per year ◦ Health survey integrated into coaching and biometric session Engagement (75% of employees or more) ◦ Defined as completing Health Survey, Biometric Screening/Coaching session 1 x per year ◦ 99.0% in person face to face, one to one private session. Telephonic and internet not as effective as face to face but used sparingly primarily as outreach Culture ◦ Without a culture of wellness, health improvements are not sustainable, no matter what the incentive is, or program design. Measure and report on culture and environmental improvements Engagement strategies ◦ Fit ticket and drawings ◦ Recognition (success stories) ◦ Teams ◦ Worksite vs. Worksite Around the World in 80 Ways (online tracking)
One to One in person face to face biometric assessments with measured fitness and coaching. Follow up appointments set at time of assessment Multiple opportunities to participate (waves of biometric assessment and coaching) Health survey done at time of biometric assessment with wellness coach. Evaluation of program health outcomes and employee satisfaction survey: baseline, 6 months, 1 year. Semi annual or annual thereafter’ Coaching protocols: MI, Self-efficacy, Stages of Change Follow up with all participants at least annually, to include rescreening, coaching and medical referral (report on medical referral success rate) Culture and environmental survey Wellness committee established, staffed by vendor company health professional ◦ Meets twice per month at the start of program ◦ Then monthly and can eventually go to quarterly in mature programs ◦ 2-4 wellness events per year ◦ Community tie in to health events. 24 hour cancer relay, pink awareness, go red for women
As health risks increase in work populations health care costs increase As health risks decrease in work populations health care costs decrease High risk persons are high cost (medical claims) Low risk maintenance programs are important in lowering costs. Risk is not static. Without effective wellness programs to help low-risk individuals maintain their low-risk status, 2 percent to 4 percent of an employee population is likely to migrate from low- risk status to a higher-risk status within one year Productivity findings follow same direction as medical costs University of Michigan Health Management Research Dee Edington, PhD
Agree on metrics of success Focus on health risk reductions Focus on creating a culture of wellness Focus on creating a healthy environment Timely reporting on all the above
Swift Worksite Assessment and Translation(SWAT)Center for Disease Control and Prevention“Best Practice Worksite”
Kalamazoo Valley Community College Prevalence of Multiple Heart Disease Risk FactorsMultiple risks geometrically increase health related costs. Holtyn typically targets50% or more of the workforce with zero heart disease risk factors. Measured risks include,poor fitness, high BP, cholesterol≥200, waist at risk, smoking, elevated glucose. KVCC Employees
GOAL 75% ParticipationCURRENT 94% Participation Goal achieved GOAL70% No or low risk for 12 Lifestyle risk factorsCURRENT 77% Goal achievedGOAL 50% No CVD risksCURRENT 66% Goal achieved Best CVD Outcomes in the countryGOAL Culture of WellnessCURRENT “Achieving and in process” High Support and Peer Scores GOAL Maintain all above goals
Trend in Twelve Lifestyle Health Risks Flexfab Corporation Hastings MIMultiple lifestyle health risk factors are being eliminated at Flexfab.Multiple risks geometrically increase health related costs. Measured risks include, poor fitness,high BP, cholesterol≥200, waist at risk, smoking, elevated glucose, high stress, low coping,depression, high alcohol intake, high fat consumption, low fruit/vegetables/fiber consumption. Flexfab Employees
Cultural Support – Touch PointsCultural Touch Point Questions: % Reporting Strong Agreement or Agreement Survey Item Oct 2005 Oct 2009 Oct 2011 My company leaders are models for a healthy lifestyle. 33% 53% 62% This company demonstrates its commitment to supporting healthy lifestyles 65% 85% 88% through its use of resources such as time, space and money. People at this company are taught skills needed to achieve a healthy lifestyle. 42% 79% 83% New employees at our workplace are made aware of the organizations support for 34% 68% 75% healthy lifestyles. People are rewarded and recognized for efforts to live a healthy lifestyle. 35% 75% 82% Flexfab Employees
Cultural Support - Peers Peer Support Questions: % Reporting Agreement or Strong AgreementSurvey Item Oct 2005 Oct 2009 Oct 2011My immediate supervisor supportsmy efforts to adopt healthier 47% 59% 66%lifestyle practices.Coworkers support one another inefforts to adopt healthier lifestyle 54% 75% 75%practices.My friends support one another inefforts to adopt healthier lifestyle 65% 79% 85%practices.My family members and/orhousemates support one another 76% 86% 87%in efforts to adopt healthier lifestylepractices. Flexfab Employees
Prevalence of Multiple Heart Disease Risk FactorsMultiple risks geometrically increase health related costs. Holtyn typically targets50% or more of the workforce with zero heart disease risk factors. Measured risks include,poor fitness, high BP, cholesterol≥200, waist at risk, smoking, elevated glucose. Hastings Fiberglass Employees
Trend in Twelve Lifestyle Health Risks Multiple lifestyle health risk factors are being eliminated at Hastings Fiberglass. Multiple risks geometrically increase health related costs. Measured risks include, poor fitness, high BP, cholesterol≥200, waist at risk, smoking, elevated glucose, high stress, low coping, depression, high alcohol intake, high fat consumption, low fruit/vegetables/fiber consumption. Hastings Fiberglass Employees
Cultural Support – Touch Points Cultural Touch Point Questions: % Reporting Strong Agreement or AgreementSurvey Item Start 2005 Oct 2011My company leaders are models for a healthy 49% 74% lifestyle.This company demonstrates its commitment to 64% 94% supporting healthy lifestyles through its use of resources such as time, space and money.People at this company are taught skills needed to 25% 92% achieve a healthy lifestyle.New employees at our workplace are made aware of 47% 68% the organizations support for healthy lifestyles.People are rewarded and recognized for efforts to 34% 94% live a healthy lifestyle. Hastings Fiberglass Employees
Cultural Support - Peers Peer Support Questions: % Reporting Agreement or Strong AgreementSurvey Item Start 2005 Oct 2011My immediate supervisor supports my efforts to 49% 74% adopt healthier lifestyle practices.Coworkers support one another in efforts to 48% 79% adopt healthier lifestyle practices.My friends support one another in efforts to 68% 86% adopt healthier lifestyle practices.My family members and/or housemates 82% 95% support one another in efforts to adopt healthier lifestyle practices. Hastings Fiberglass Employees
GOAL 75% ParticipationCURRENT 100% Participation Goal metGOAL 70% No or low risk for 12 Lifestyle factorsCURRENT 82% Surpassed goal!GOAL 50% No CVD risksCURRENT 45% Multiple risks being eliminatedGOAL Culture of WellnessCURRENT Improvements in all categoriesGOAL Maintain all above goals for multiple yearsCURRENT Results improving GOAL Fun! Hastings Fiberglass Employees
Comprehensive Model, Evidence/Science Based Face to face assessment and coaching Culture and environment focus Long term commitment, minimum 3 years Budget Investment $350 per employee Impeccable Execution It takes time even in small worksites
Wellness Outreach At WorkSAMHSA’s National Registry of Evidence-based Programs and Practiceshttp://nrepp.samhsa.gov/ViewIntervention.aspx?id=56#Study 3Reaping the Rewards of Worksite Wellnesshttp://www.hopehealth.com/pdf/FreeReports/RewardsofWorksiteWellnessReport.pdfWellness Manual: Successful Workplace Wellness Programshttp://hopehealth.com/pdf/FreeReports/SuccessfulWorkplaceWellnessProgramsReport.pdfSWIFThttp://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/swat.htmPromising practices in employer health and productivity management efforts: findings from abenchmarking study.J Occup Environ Med. 2007 Feb;49(2):111-30.http://www.logisens.com/resourceFiles/PromisingPracticesGoetzel.pdfWorkforce Wellness Indexhttp://healthpromotionlive.com/2011/08/ron-goetzel-of-emory-universitythomson-reuters/