We will discuss how Zero Trends: Health as a Serious Economic Strategy and the evidence for the Five Pillars can be used to accomplish a workplace and workforce that truly embraces Shared Values Shared Results. This can be accomplished by a Strategic, Systematic, Systemic and Sustainable (4S) organizational strategy.

1. Realizing the promise and Competitive Advantage of a:
“Thriving, Healthy, High-Performing and
Sustainable Workplace and Workforce”
April 25, 2014
©2014 Edington Associates
Edington Associates LLC
Shared Values-Shared Results™

2. ©2012 Edington Associates 2
First 35 Years of Work
Zero Trends:
Health as a Serious Economic Strategy

3. 0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Less than 45 45 to 64 Greater than
65
3.00% 10.50%
18.60%
9.50%
32.00%
61.40%
25.30%
56.40%
80.00%
Low Risk
Excess Diseases Associated with Excess Risks (Heart,
Diabetes, Cancer, Bronchitis, Emphysema
Percent with
Disease
Med Risk
Age Range
High
Musich, McDonald, Hirschland, Edington. Disease
Management & Health Outcomes 10(4):251-258, 2002.

4. ©2012 Edington Associates
4
Natural Flow: by Risk Status
1640
(35.0%)
4,163
(39.0%)
678
(14.4%)
High Risk
(>4 risks)
Low Risk
(0 - 2 risks)
Medium Risk
(3 - 4 risks)
2,373 (50.6%)
21,750 (77.8%)
4,546
(42.6%)
10,670 (24.6%)
4,691 (10.8%)
27,951 (64.5%)
11,495 (26.5%)
5,226 (12.1%)
26,591 (61.4%)
892
(3.2%)
1,961
(18.4%)
5,309
(19.0%)
Modified from Edington, AJHP. 15(5):341-349, 2001
Average of three years
between measures

5. ©2012 Edington Associates 5
Natural Flow of a Population by: Risks-Costs-Age
$0
$3,000
$6,000
$9,000
$12,000
19-34 35-44 45-54 55-64 65-74 75+
$1,776
$2,193 $2,740
$3,734
$4,613
$5,756
$1,414
$2,944
$3,800
$5,212
$6,636
$8,110
$2,565
$3,353
$4,620
$6,625
$7,989
$8,927
$5,114
$5,710
$7,991
$10,785
$11,909 $11,965
Low
Annual Medical
Costs
Med Risk
Age Range
High
Non-Participant
Edington. AJHP. 15(5):341-349, 2001

6. ©2012 Edington Associates 6
Natural Flow of a Population
Challenge!
Can you beat the Natural Flow?
One of our major learnings over the 35
years at the UM-HMRC was that the
ultimate objective is to beat the Natural
Flow of Risk and Costs.

7. ©2011 Edington Associates 7
Wellness Strategies: 2013 and Before
Healthier
Person
Better
Employee
Gains for the
Organization
Health Status
Disease Care Costs
Health Care Costs
Productivity
Absence
Disability
Worker’s Comp.
Presenteeism
Company Visibility
Social Responsibility
1981, 1995, 2000, 2006, 2008
Lifestyle
Change
Health and
Disease
Management
Programs
Behavior Change
(Wellness)
Treating Disease
(Medical)

8. 8
Don’t Get Worse
Help the Low-Risk
stay Low-Risk
Help the High-Risk
move to Low-Risk
Recommendations
for the Population
after 30 years of
work 1977-2009
(Zero Trends)

9. 9
Vision from
Zero Trends
Zero Trends provides a
transformational approach
Populations throughout the
world live and work within a
thriving, healthy, high
performing and sustainable
workplace and workforce
Based upon over 900 Publications
and Presentations
©2012 Edington Associates

10. ©2012 Edington Associates 10
Next Practices
Beyond Zero Trends:
2014 and Beyond

11. Business Strategies to Cope with
Disease, Health, Well-Being
AND
Build a Thriving, High Performing
and Sustainable Workplace and
Workforce
Past to Current to Future Strategies

12. Senior Leadership Lack of support
Lack of clear vision
Operations Leadership Supervisor lack of support
Lack of supportive culture
Incomplete communications
Self Leadership Don’t understand why, what, how
Lack of self-efficacy
Lack of time, convenience
Recognize Strengths Lack of positive recognition
Quality Assurance Lack of feedback on progress
Lack of shared values, vision
12
Previous Barriers during Implementation
©2013 Edington Associates

13. 13
Business Strategy for Health
©2012 Edington Associates

14. ©2013 Edington Associates
Beyond Zero Trends: Thriving, High Performing and
Sustainable Workplace and Workforce
Thriving and
High Performing
Workplace-Workforce
Champion Company
Gains in Workplace
and Workforce
Objectives
Health Status
Personal Economics
Health Economics
Disability
Time away from work
Recruitment
Retention
Engagement
Social-emotional
Happiness
Quality of Life
Social Visibility
Employer of Choice1981, 1995, 2000, 2006, 2008, 2013 Edington Associates
Create a
Supportive
Environment
and Culture
Create the
Vision and
Strategy
Move Health into the Culture
•Senior Leadership
•Operations Leadership
•Self-Leadership
•Recognize Positive Acts
•Quality Assurance

15. Enterprise Wide Engagement
Best Place
to Work
Wellness and
Wellbeing
All Stakeholders
Marketing and
Branding
Senior Leaders
Strategy Quality
Communications
Internal and
External
Engagement
Talent
All Managers
Production
The whole is greater than the sum of the parts!!!
Culture and Environment
Safety

16. Champion Company Process---Systematic
Vision Builder
Capture and Store
Objectives
Administration of
Audit and Surveys
(Culture, Environment,
Community)
Tracks progress
toward goals for:
• Pillars
• Process
• Outcomes
16
Corporate Positioning
System
Develop vision and purpose
Outline objectives
Build or engage in committee
structure – expand to support
strategic level initiative
Present results and
Strategic recommendations
to senior stakeholders
Agree on final strategy. Develop
Success Metrics and Work Plan
Senior Leaders, Program
Owners, Managers, Employees
On- or off-line
Administration
Online views for all
Stakeholders
“Real-time” tracking
of Journey process
• White boxes represent
consultation processes
• Yellow boxes represent
system supported
processes
Define and track
success targets
5) Strategy Session
with Stakeholders
Qualitative
Inquiry
Perception of
Culture Survey
Environmental
Audit
1) Strategic Session(s)
with CEO and C-Suite
2) Executive Steering
Committee
6) Train all
Stakeholders
Wellness Committee/
Work Teams
4) Present Gap
Analysis Findings
Continuous Assessment and
Improvement
3) Conduct Organizational Health Assessment
©2012 Edington Associates
Pre-Engagement
Planning

17. 17
Built on a Comprehensive Impact Framework
PROCESS AND
ENGAGEMENT
FOUNDATIONS
Senior Leadership
Healthy Environment, Healthy Culture
Engaged
Employees
I. Evaluate the
Foundations
II. Evaluate Process
and Engagement
III. Evaluate Impact
Continuous
Feedback
Loop
Operations
Leadership
Self-Leadership Recognition Quality Assurance
Knowledge Comes When
Relationships are
Connected to Outcomes
Psychosocial
Impact
Health Status,
Life Satisfaction
Health and Safety
Behaviors
Health and Well-Being Metrics
Productivity
Work Satisfaction
Service Utilization
Healthy
Company
Short-term Moderate-Term Longer-Term
Healthy People
Financial Outcomes
Organizational Impact
Social Support
Family and Friends
Community
Relationships
Supervisor and
Colleagues
Healthy
Relationships
OUTCOMES

18. ©2013 Edington Associates 18
Journey towards a Shared Values Company
Communication
and
Outreach
Enrollment
and
Engagement
Prevention
and
Wellness
Risk
Management
Disease
Management
Workforce
•Engaged
•Thriving
Best Place to Work
Workplace
•Shared Values
•Positive Return
Clear Vision, Metrics,
Culture and Environment
Vision,
Commitment,
Leadership
Supportive
Culture and
Environment
Workforce
•Engaged
•Thriving
Prevention
and
Wellness
Risk
Management
Disease
Management
Initiatives Along the Health
Continuum
Program Impact
Best Place to Work
Workplace
•Shared Values
•Positive Return
Enterprise Commitment
and Support
Impactful Thriving, Healthy and
Well-Being Programs
Sustainable Initiative
to support the Vision
C
Strategic Systematic Systemic Sustainable

19. Principles of Senior Leadership
Step #1 Strategic
Create the Vision
•Connect vision to business strategy
•Provide measures to get to vision
•Commitment to healthy culture
•Provide adequate resources
•Leadership ownership and engaged
“Establish the business value of a healthy and
high performing organization and workplace as
a world-wide competitive advantage”©2010: Health Transformation Group, LLC 19

20. 20
Vision
Vision for a Culture of Health (Example)
“… a sustainable culture of health where
individual’s quality of life, state of well-
being, empowerment and engagement are
thriving”

21. ©2013 Edington Associates 21
Committed , vocal and enthusiastic
leadership promotes:
•Increased awareness
•More motivated employees
•Shared Values
•Clear Vision and Metrics
Levers of Program Success: Pillar 1-Strategic
Pillar 1:
Senior
Leadership
Strong Vision
Visible
Committed
Leadership
Communication
and
Outreach
Enrollment
and
Engagement
Prevention
and
Wellness
Risk
Management
Disease
Management
Workforce
•Engaged
•Thriving
Best Place to Work
Workplace
•Shared Values
•Positive Return
Clear Vision, Metrics,
Culture and Environment
Vision,
Commitment,
Leadership
Supportive
Culture and
Environment
Workforce
•Engaged
•Thriving
Prevention
and
Wellness
Risk
Management
Disease
Management
Initiatives Along the Health
Continuum
Program Impact
Best Place to Work
Workplace
•Shared Values
•Positive Return
Enterprise Commitment
and Support
Impactful Thriving, Healthy and
Well-Being Programs
Sustainable Initiative
to support the Vision
C

22. Alignment of Policies with Vision
•Assess Organizational Health
•Fix the gaps in the environment and
culture
•Train all employees in What, Why, How
•Conduct a wellness program audit
•Brand health management strategies
“You can’t put a changed person back into the
same environment and expect the change to hold”
Principles of Operations Leadership
Step #2 Systematic, Systemic
22©2010: Health Transformation Group, LLC
Not for Distribution

23. ©2013 Edington Associates 23
Supportive culture and environment:
•Create supportive employee health in
the Environment and Culture
•Reduce barriers to self-leadership
•Further increases participation and
strengthens engagement
•Support for self-leadership
Pillar 1:
Senior
Leadership
Strong Vision
Visible
Committed
Leadership
Pillar 2:
Operations
Leadership
Culture of
Health
Supportive
Environment
Communication
and
Outreach
Enrollment
and
Engagement
Prevention
and
Wellness
Risk
Management
Disease
Management
Levers of Program Success: Pillar 2-Systematic
Workforce
•Engaged
•Thriving
Best Place to Work
Workplace
•Shared Values
•Positive Return
Clear Vision, Metrics,
Culture and Environment
Vision,
Commitment,
Leadership
Supportive
Culture and
Environment
Workforce
•Engaged
•Thriving
Prevention
and
Wellness
Risk
Management
Disease
Management
Initiatives Along the Health
Continuum
Program Impact
Best Place to Work
Workplace
•Shared Values
•Positive Return
Enterprise Commitment
and Support
Impactful Thriving, Healthy and
Well-Being Programs
Sustainable Initiative
to support the Vision
C

24. Systemic
Create Winners
•Help people not get worse
•Help health people stay healthy
•Train in basic concepts of living
and Thriving
•Provide improvement, wellness
and maintenance programs
“Create winners, one step at a time and the first
step is don’t get worse’
Principles of Self-Leadership
24©2010: Health Transformation Group, LLC
Not for Distribution
Step #3

25. ©2013 Edington Associates 25
Promote self-leadership
•Greater self efficacy
•Increased commitment
to stick to it
•Develop Life Skills
•Promote Engagement
Pillar 1:
Senior
Leadership
Pillar 2:
Operations
Leadership
Strong Vision
Visible
Committed
Leadership
Culture of
Health
Supportive
Environment
Communication
and
Outreach
Enrollment
and
Engagement
Prevention
and
Wellness
Risk
Management
Disease
Management
Levers of Program Success: Pillar 3-Systemic
Pillar 3:
Self-
Leadership
Create Winners
• Help Employees
Not Get Worse
• Help Healthy
People Stay Healthy
Workforce
•Engaged
•Thriving
Best Place to Work
Workplace
•Shared Values
•Positive Return
Clear Vision, Metrics,
Culture and Environment
Vision,
Commitment,
Leadership
Supportive
Culture and
Environment
Workforce
•Engaged
•Thriving
Prevention
and
Wellness
Risk
Management
Disease
Management
Initiatives Along the Health
Continuum
Program Impact
Best Place to Work
Workplace
•Shared Values
•Positive Return
Enterprise Commitment
and Support
Impactful Thriving, Healthy and
Well-Being Programs
Sustainable Initiative
to support the Vision
C

26. 26
Incorporate Determinates of Health
IndividualSupportive
Community
Supportive
Family and
Friends
Supportive
Workplace
Thriving
Employee
©2012 Edington Associates
Living and Thriving Assessment

27. ©2012 Edington Associates 27
Lifestyle Scale for Individuals, Populations,
Self-Leaders: Beyond Zero Trends
Chronic
Signs &
Symptoms
Feeling
OK
Premature
Sickness,
Death &
Disability
High-Level
Wellness,
Energy,
Vitality
Edington. 1983, Modified 2008, Modified 2012
Chronic
Signs &
Symptoms
Feeling
OK
Premature
Sickness,
High-Level
Wellness
Self-Leader
Thriving
Sustainable
Energetic
Well-Being

28. Vision for Self-Leadership in Individuals
Personal
Control
Optimism
Self-Leadership
Resilience
Confidence/
Self-efficacy
Self-
Esteem
 Knowledge
 Health Literacy
 Negotiation Skills
Vitality/Vigor
 Consumerism
 Engaged
patient role
 Social Support
− Colleagues
− Community
− Family
 Environment
and culture
28© 2012 Edington Associates
Other characteristics: Change, Integrity, Trust, Thrive, Enthusiasm, Ethical,
Spiritual, Creative, Flexible,
Low-Risks and Behaviors
Purpose, Values, Mission, Vision

29. Positive Outlook

Happiness

Brain Health
Emotions &
Intuitions

Mental
Shortcuts and
Biases

Environment
Values

Purpose

Vision
Focusing on
Strengths

Positive
Reframing

Creating a Plan
for Change
Fundamental Skills to Build Self-Leaders

30. ©2014 Edington Associates 30
Additional Determinates of Health
Beyond Zero Trends (early second quarter, 2014)
1. Advance definition of health (beyond medical)
2. The science of thriving, flourishing, flow, focus, other
3. Positive psychology positive organizations
4. The influence of a positive outlook
5. The mind-body connection
6. Advances in brain science
7. Environment and Culture
8. Social connections, support

31. ©2014 Edington Associates 31
Additional Determinates of Health
Beyond Zero Trends (continued)
9. Anxiety and stress
10. Self-Determination Theory
11. Behavioral economics
12. Personal economics
13. Shared values shared results
14. Best and next practices
15. Considerations of Health, well-being, wellness
16. New Methods, Measures and Metrics

32. Surveys and Quizzes
32
© 2012 Edington Associates

33. Interactive Activities – Example (Values)
33© 2012 Edington Associates

34. Systemic, Sustainable
Reinforce the Culture of Health
•Alignment of recognition to the vision
• Reward champions
• Set incentives for healthy choices
• Reinforce at every touch point
“What is rewarded is what is sustained”
Principles of Positive Actions
34©2010: Health Transformation Group, LLC
Not for Distribution
Step #4

35. ©2013 Edington Associates 35
Recognize
positive actions:
•Reinforces healthy,
well-being behaviors
•Promote Shared Values
•Develop intrinsic
motivation
•Promote Self-
Efficacy
Pillar 4:
Recognize
Actions
Pillar 1:
Senior
Leadership
Strong Vision
Visible
Committed
Leadership
Recognize
Champions
Reinforce at
every touch
point
Clear Vision, Metrics,
Culture and Environment
Vision,
Commitment,
Leadership
Supportive
Culture and
Environment
Workforce
•Engaged
•Thriving
Prevention
and
Wellness
Risk
Management
Disease
Management
Initiatives Along the Health
Continuum
Program Impact
Best Place to Work
Workplace
•Shared Values
•Positive Return
Enterprise Commitment
and Support
Levers of Success: Pillar 4-Systemic
Pillar 3:
Self-
Leadership
Pillar 2:
Operations
Leadership
Culture of
Health
Supportive
Environment
Create Winners
• Help Employees
Not Get Worse
• Help Healthy
People Stay
Healthy
C
Impactful Thriving, Healthy and
Well-Being Programs
Sustainable Initiative
to support the Vision

36. Sustainable
• Integrate all data
• Evaluate program outcomes
• Use a conceptual outcomes framework
• Provide feedback on how progress was
obtained and steps to get to vision
• Feedback on leadership, culture, self-
leadership, positive actions, economic
outcomes
“Supports decisions with evidence”
Principles of Quality Assurance
36©2010: Health Transformation Group, LLC
Not for Distribution
Step #5

37. 37
CPS Platform-Organizational Health
Program
Process Data3
Environmental
Audit
Perception of
Culture Survey
Health
Assessment
Data1
Productivity
Data2
Service
Utilization2
Self-
Leadership
Modules3
Inputs
Proprietary
Algorithms
Consolidated
Data
Comprehensive and
Timely Feedback
Guides the Journey
Edington
Engine
1Health assessment data can be collected via the Healthy Life Assessment, or HRA data from an external source can be mapped and uploaded.
2Assessments in CPS collect self-reported information. Data from external sources (i.e., short- and Long-term disability claims, medical and
pharmacy claims, etc., can be mapped and uploaded as needed. 3External data feeds
• Trends and
Metrics
• Reports
• Scorecards for…
Outputs
Outcomes Based on a
Comprehensive
Evaluation Framework
©2013 Edington Associates

38. 38
Provides Feedback and Communication
Online Platform for
Stakeholders of Health
Companywide
Senior Leadership
Program Owners
Employees
Edington
CORPORATE
POSITIONING
SYSTEM
Cultivates True
Engagement
Managers
©2013 Edington Associates
CPS

39. 39
How Does the CPS Work?
Energized Workforce
100%
Corporate Positioning System
Healthy Culture
and Environment
100%
Disengagement
and Stress
>50%
Provides a clear view of:
• Where you are today (Gap Analysis)
• Where you want to go (Vision, Objectives)
• How you plan get there (Strategic Planning)
• Roadblocks, Detours (Ongoing Evaluation)
• Whether you are on track (Reports, Dashboards)
• Are we there yet? (Success Metrics)
A Guided Journey that….
©2012 Edington Associates
CPS

40. ©201s Edington Associates 40
Pillar 5:
Quality Assurance
Continuous Improvement
Continuous feedback of
information about program
processes and outcomes
Communication
and
Enrolment
Engagement
and
Culture
Prevention
and
Wellness
Case
Management
Disease
Management
Levers of Program Success: Pillar 5-Sustainable
Pillar 3:
Self-
Leadership
Pillar 4:
Recognize
Actions
Pillar 1:
Senior
Leadership
Pillar 2:
Operations
Leadership
Workforce
•Engaged
•Thriving
Best Place to Work
Workplace
•Shared Values
•Positive Return
Clear Vision, Metrics,
Culture and Environment
Vision,
Commitment,
Leadership
Supportive
Culture and
Environment
Workforce
•Engaged
•Thriving
Prevention
and
Wellness
Risk
Management
Disease
Management
Initiatives Along the Health
Continuum
Program Impact
Best Place to Work
Workplace
•Shared Values
•Positive Return
Enterprise Commitment
and Support
Impactful Thriving, Healthy and
Well-Being Programs
Sustainable Initiative
to support the Vision
C

41. ©2012 Edington Associates 41
Summary
Summary

42. 3 Strategic
Vision
from
Leaders
Systematic
& Thriving
Shared
Values
Systemic
Engage all
in the
Workplace
Recognize
Positive
Actions,
Work Team
Sustained
Progress
in all
areas
2 Speech
from
Leader
Internal
Wellness
Program
Screenings
& Reduce
High-Risks
Coaching
Incent
High-Risk
Reduction
Change in
Risks, ROI
1 Inform
Leader
Out-
source
Wellness
Screenings
& Reduce
High-Risks
Incent
High-Risk
Reduction
Change in
Risks
0 Do
Nothing
Do
Nothing
Do
Nothing
Do
Nothing
Do
Nothing
Pillar 1 Pillar 2 Pillar 3 Pillar 4 Pillar 5
Which Sustainability Level is for You
Sustainability
Rating
Do Nothing
Champion
Comprehensive
Traditional
Senior
Leadership
Operations
Leadership
Self-
Leadership
Rewards
for Positive
Actions
Quality
Assurance
Five Pillars
©2012 Edington Associates

43.  Phone: 734.998.8326 (USA)
 Email: dedington@edingtonassociates.com
jspitts@edingtonassociates.com
jmcintyre@edingtonassociates.com
jmrichardson@edingtonassociates.com
 Website: www.edingtonassociates.com
 Address: Edington Associates LLC
University of Michigan
North Campus Research Center
1600 Huron Parkway
Ann Arbor MI 48109
©2012 Edington Associates 43
Thank you for your attention