Designing Effective Wellness Programs

1. Designing Effective Wellness Programs Bruce Coulter, CPE Department of Labor and Industries

2. My Discussion • Wellness/Health Promotion Programs • Challenges in the Trucking Industry • Designing the Effective Program • Business Plan • Integration • Benefits • Culture

3. Workplace Health Promotion in Washington State Current Research Findings

4. Commercial Truck and Bus Safety Health and Wellness Programs for Commercial Drivers

5. welcoa.org

6. Why Health Promotion? • Reduces costs • direct costs: medical insurance, health care, workers’ compensation, accidents, absenteeism • indirect costs: employee job satisfaction and driver retention • Increases • Morale, productivity, overall health

7. Wellness/Health Promotion • Employee Health and Wellness (H&W) programs have been around for the past 30 years • Driven by: • Concern for employees • Need to control healthcare/workers’ comp costs • Desire to decrease absenteeism, lost productivity

8. What Are The Issues? Health Risk Factors (characteristics associated with increased rates of disease) • Tobacco use • Obesity • Lack of physical activity • High Blood Pressure • Poor eating habits • Use of alcohol, drugs and other chemical substances • Various forms of psychological and job stress

9. CDC 365,000 deaths per year 435,000 deaths per year

10. 416 435,000 + 365,000 = 800,000/416 = 1923 1923/365 = 5.27 per day or 2192 people

11. Qantas Gripe Sheets • P: Left inside main tire almost needs replacement. • S: Almost replaced left inside main tire. • P: Test flight OK, except auto-land very rough. • S: Auto-land not installed on this aircraft. • P: Something loose in cockpit. • S: Something tightened in cockpit. • P: Dead bugs on windshield. • S: Live bugs on back-order. • P: Autopilot in altitude-hold mode produces a 200 feet per minute descent. • S: Cannot reproduce problem on ground. • P: Evidence of leak on right main landing gear. • S: Evidence removed.

12. Qantas Gripe Sheets • P: DME volume unbelievably loud. • S: DME volume set to more believable level. • P: Friction locks cause throttle levers to stick. • S: That's what they're there for. • P: IFF inoperative. • S: IFF always inoperative in OFF mode. • P: Suspected crack in windshield. • S: Suspect you're right. • P: Mouse in cockpit. • S: Cat installed.

13. Qantas Gripe Sheets • P: Noise coming from under instrument panel. Sounds like a midget pounding on something with a hammer. • S: Took hammer away from midget. • P: Number 3 engine missing. • S: Engine found on right wing after brief search. • P: Aircraft handles funny. • S: Aircraft warned to straighten up, fly right, and be serious. • P: Target radar hums. • S: Reprogrammed target radar with lyrics.

14. Wellness Program Evolution • Traditional wellness programs • Topic of the month, non targeted, general wellness topics (nutrition, exercise, stress) • Disease management • Comprehensive campaign on a major health risk • Web based • On line participation in HRA’s, initiatives, coaching

15. The Hard Truth • Success is varied and often tied to the efforts of internal champion • Challenge is that H&W is ultimately a personal lifestyle choice • Companies can educate, encourage and even incentivize wellness, however, ultimate decision rests with individual AND Human behavior is very hard to change

16. Factors Affecting Trucker Health • Long workdays…sitting • Whole Body Vibration • Static Posture • Bursts of highly physical work • Poor dietary choices on the road • Sleep issues • Deprivation • Disruption • Circadian and biological rhythm interruption • Days, weeks away from home • Decentralized

17. Most Common H&F Risks for Drivers • Poor health habits • Driver injuries • Driver fatigue • Driver illness • Regular tobacco use • Overweight/obese • Hypertension • Poor eating habits • Lack of physical activity • Abuse of • Alcohol • prescription and non-prescription drugs • OTC cold remedies • Energy drinks

18. Manager results: Unhealthy diet Obesity Stress Uncontrolled hypertension Sleep disorders Drug/Alcohol use Driver results: Sleep disorders Drug/Alcohol use Stress Obesity Unhealthy diet Uncontrolled hypertension ATRI Survey of the Greatest Health Risks Facing Drivers

19. Exercise/physical activity opportunities Nutrition training/information Weight management Nicotine prescriptions Tobacco cessation Responsible alcohol use Cardiovascular disease prevention Medication management Disease management for issues such as diabetes and hypertension Flu shots Fatigue awareness Screening for sleep disorders Focus on ergonomics (cab comfort) Top H&W Program Activities

20. Driver Survey What can be done to get more drivers involved in H&W program? • Offering weight room/exercise equipment for drivers • Start a company sports team • Government mandate on H&W program participation

21. Employee health risk appraisal Nutrition & diet advice/assistance Weight management program Physical fitness programs Blood pressure screening Regular distribution of H&W materials Safe driving practices and promotion of seat belt use Makes healthy food options available Encourages drivers’ family members to participate in H&W programs Ensures all vehicles are maintained in ergonomically sound condition Drivers – Components Offered and Utilized the Most

22. United States Preventive Services Task Force (USPSTF) • Hypertension • Lipid disorders • Obesity • Tobacco use • Breast, cervical, colorectal cancers

23. Advisory Council on Immunization Practices (ACIP) • Annual Influenza Vaccination for those over 50

24. National Commission on Preventive Priorities • Ranked preventive care by health impact and cost-effectiveness • Tobacco use screening and cessation programs42,000 deaths averted annually • Colorectal screening14,000 deaths averted annually • Influenza vaccination12,000 deaths averted annually

25. Washington Workers Behavioral Risk Factor Surveillance System (BRFSS) data • 76.3% do not eat enough fruits and vegetables • 61.7% are overweight or obese • Smoking • 32.4% uninsured • 14.8% insured • 3 times as common in homes with annual income < $25,000 than households with incomes >$75,000

26. Resources • Guide for Community Preventive Services

27. Design of an Effective Program • Business Plan (ROI, P/L, PDCA) • Integration • Benefits • Culture

28. Business Plan • Health Promotion is at the level of Senior Management Team • Reports relevant measures regarding the human resource • Costs and cost savings using health metrics • Budget to cover all screenings and prevention activities • In current corporate environments capital is distributed by demonstrated need and whether the capital distributed was effectively used to help the bottom line • Reported in Annual Report to Shareholders

29. Integration • New Employee Orientation • Benefits sign up • Tiered Premiums • Newsletter to Family • Annual HRA (mandatory for benefits) • Baseline data • Benefit programming (free)derived from HRA Results

30. Benefits • Free Primary, Secondary and Tertiary Prevention • Free screenings • Mammography • Colonoscopy • BP • Cholesterol • Free Tobacco Cessation Programs • Support for existing conditions (HBP, diabetes)

31. Benefits • Percent of employee health insurance costs should be consistent with their participation in the program • Discounts begin with completion of an HRA • Discounts increase with participation in relevant programming • Full discount after demonstration of reduced risk (lowered BP, smoking cessation)

32. Evaluating Effectiveness Pitfalls • Employee behavior is often measured by health risk appraisals that have low participation rates and overrepresentation of health-conscious workers • Participants are often compared with nonparticipants, resulting in strong selection bias and overestimation of intervention effect • Workplace evaluation efforts often focus either on • inputs such as program delivery that does not capture participation and behavior change • disease outcomes, which are slow to change and may be affected by factors outside the intervention.

33. Evaluating Effectiveness Practitioners working with employers can offer more effective workplace evaluation by: • continually tracking intervention delivery and employee participation • measuring relevant behavior change

34. Incentives • Better to remove disincentives than install incentives • Barrier-reduction interventions, such as eliminating out-of-pocket costs for tobacco use cessation, should take priority for 2 reasons. • they have the broadest reach — to workers, dependents, and retirees — and can affect all workers, even those who do not participate in interventions • financial barriers are most important for low-income workers with limited means

35. Benefits • Wellness Programming should be part of the benefits package • HRA should be a requirement for employees to receive benefits • Tobacco/alcohol cessation should be fully funded • Screenings should be fully funded

36. Culture • Culture comes from management walking their talk. • Signs don’t work, actions do. • Celebrating success, learning from failure. • If your drivers are your most valuable resource, they need to feel that.

37. Other areas to address • Depression • MSDs • Sleep Disorders • Stress • Substance Abuse

38. How Do I Get Started? • Remember – H&W program does not need to be all encompassing to begin to address driver health issues • Small, incremental steps will make a difference • Make sure commitment to improving driver H&W starts at the top and is communicated as such

39. How Do I Get Started? • Analyze health care and w/c claims to identify most prevalent health risks • Develop your comprehensive plan with representatives from labor and management and your champion • Scope • Mission statement, measureable goals and objectives • Measurement • Realistic budget • Criteria for success (five year plan)

40. How Do I Get Started? • Implement an HRA which will be mandatory if employees are to receive free health benefits • Legal needs to weigh in on HIPAA, and health insurance security.

41. Starting Small • Mail monthly H&W info to drivers’ homes for driver and family • Dedicate section of company newsletter to H&W issues • Remember the power of peer pressure and peer influence - drivers provide the best testimonials for one another • Meet employees where they are.

42. Stages of Change • Pre-contemplation • Contemplation • Preparation • Action • Maintenance • Termination

43. It Didn’t Work… • Not convenient/not accessible, particularly for over-the-road drivers • Takes too long to see the results – set goals too high • Lack of management support (management not healthy either) • No one assigned to manage the wellness program • Failure to involve front-line management • Championing the program often doesn’t start at the top • Actions don’t support the message (e.g., serving donuts or pizza as a snack or meal during wellness training)

44. It Didn’t Work… • Champion gets program going and then gets promoted or leaves; no depth in management to carry on • Missing a clear statement of philosophy, purpose and goals • Ineffective communication • Failure to involve employee’s spouse/family - drivers need support on home front to reinforce the message, change diet, reduce stress, etc. • Unrealistic budget • Work culture/environment is unsupportive – vending machines, smoking areas

45. It Will Work… • Do your homework to know what the H&W issues are • Set realistic goals and objectives AND performance measures • Commitment must be top-down • Smart small and dedicate resources (human and financial) to each step • Empower drivers to be a part of the process including determination of program components • Encourage and foster teamwork among drivers toward common goal

46. My Recommendations • Find and maintain a champion • Budget for programs completely • If you believe in programs, fully fund them • Eliminate dis-incentives • Meet people where they are • Stay with it • Understand that the participation rate will be low for some time • Integrate wellness and safety and health, they belong together anyway (Health and Productivity). • Wellness is a performance measure.

47. thank you for listening Thanks for being here! Do you have questions? Any Questions?