Posts from — December 2008

Wellness Program organization plan review (from Key #19)
• A Wellness Program organization plan is a roadmap for success.
• Your Wellness Program organization plan should convincingly demonstrate that your Wellness Program will help the organization to achieve its goals.

More smart Wellness Program organization planning strategies

Planning the Wellness Program
• Find out how your organization plans so that your planning process will be in sync with what already happens in the company.
• Involve other people. A planning team brings their combined experience and perspective to the process. Including potential partners as you plan will make it easier to get their buy-in later.

Thinking of the big picture
• Consider the barriers and challenges that might be encountered during Wellness Program implementation. Develop strategies ahead of time to overcome these potential problems.
• Do a SWOT analysis and examine Strengths, Weaknesses, Opportunities, and Threats.

This analysis will help you identify potential problem areas or resource shortfalls as well as opportunities for growth or increased partnerships with other company personnel.

The WORST organization planning strategy: sitting in your office; working by yourself.

The best Wellness Program organization planning strategies
• Get out of your office; get out of the organization. The more people you involve in the Wellness Program planning process, the better. Always look for ways to expand your network.
• Keep your budget people informed. Get to know their philosophy of financial management.
• Be able to articulate the impact if your budget is not fully funded.
o Avoid basing your impact-if-not-funded argument solely on: “We have to.”
o Instead, describe the impact-if-not-funded with phrases like: injuries to workers, raised compensation costs, raised medical care costs for patients, lost work time, loss of licenses/accreditations, loss of workload to the Tricare network.
• Have purchase requests ready to be submitted. There is often a short window of time to process these requests. Having the information gathered ahead of time will make it easy to submit the information right away.

A well thought-out Wellness Program organization plan is essential in these times of shrinking budgets and resources. A good organization plan will help you gain leadership support and help you get and keep resources needed to implement the Corporate Health Promotion Program.

A organization plan is a roadmap for success. Use the guidelines below to develop a realistic organization plan and budget for your Corporate Health Promotion Programs.

What is a organization plan?

• A plan for success
• A document that convincingly demonstrates that your Wellness Program will help the business to achieve its goals.

Questions to ask when developing a Wellness Program organization plan
• Why do you need to do the Corporate Health Promotion Program?
• What are you going to do?
• Where are you going to do it?
• Who is the target audience?
• How are you going to do it?
• Who is going to implement the Corporate Health Promotion Program?
• How much will the Wellness Program cost Senior Management?
• What is Senior Management going to get out of the Corporate Health Promotion Program? Why should Senior Management invest in the Corporate Health Promotion Program?

Wellness Program organization Plan Components
• Title and duration of the Wellness Program
• Points of contact
• Background information (description of need; bibliography/literature review; how the Wellness Program will help achieve the organization’s goals)
• Wellness Program description
• Goals and objectives
• Implementation site
• Target population
• Work plan
• Partnerships and collaborations
• Timelines and milestones
• Budget and resource requirements (dollars and people)

Gaining the support of leadership
• Clearly link the Wellness Program goals and objectives to the organization’s strategic plan.
• Focus on the desired outcomes.
• Use the right language for the right audience. For example, Senior Management is interested in decreased clinic visits, increased provider productivity, management of the health of the population. However, Senior Management is interested in increased readiness, decreased lost duty/training time, and decreased disability and FECA claims.
A well thought-out Wellness Program organization plan will help you gain leadership support, help you get and keep resources needed to implement the Corporate Health Promotion Program, and keep the Wellness Program on track towards meaningful outcomes.

As they say: “timing is everything.” Use the guidelines below to guide the timing of Wellness Program activities and data collection.

Timing: Wellness Program Start-up
• Consider the optimal time to start a new Corporate Health Promotion Program. Take into account preferences of the target population and other factors that could affect enrollment and participation.
• For example, coordinating the start of an adult weight management initiative with the start of school in August or September may be a good tie-in with a “fresh start.”
• On the other hand, starting an adult weight management initiative In January may not be a great idea because of the constraints that weather may put on exercising outdoors.
• Take advantage of other timing cycles at your company. Planning a marketing blitz just after the PCS turnover has been completed is a good way to let new personnel know what Wellness Program options are available.

Timing: Wellness Program Participant Support
• Consider how frequently Wellness Program sessions should be offered to provide the best support and education for members and the best opportunity for success.
• Get feedback from members regarding what session frequencies work best for them.
• Consider the timing for other support mechanisms like email encouragement. What timing of those messages will benefit members most: Weekly? Bi-monthly? Monthly?

Timing: Wellness Program Data Collection
• Collecting information is an excellent way to track member progress and also to identify potential problems within a Corporate Health Promotion Program. So, give some thought to the frequency and timing of data collection.
• Select metrics that can realistically change during the Wellness Program implementation time period. For example, BMI and weight may not change very much during a 10-week Corporate Health Promotion Program; however, step counts are more likely to noticeably change.
• Some information, such as member responsiveness to out-of-class assignments (like food journals) and other interim data (like step counts) will provide important information needed to “adjust fire” as needed and make Wellness Program changes if something is not working.
• Be flexible regarding data collection frequency. Instead of requiring that members complete an physical fitness log every day, for example, consider asking for a “snapshot” summary from two or three days during the week. You will still get information to review, but members will have an easier time complying with the assignment.

Timing: Wellness Program Follow-up
• Because the we are such a mobile population, it’s best to plan some sort of post-Corporate Health and Wellness Program follow-up data collection within two to four months after the Wellness Program ends.
• You can always try to collect additional follow-up data at 6 or 12 months after Wellness Program completion. However, if you collect the information sooner, you’ll at least have collected some short term Wellness Program impact information before members are lost to follow-up.

Wellness Program communication is important to all aspects of Wellness and preventive medicine and is relevant to:
• Healthcare provider-patient relationships
• An individual’s exposure to, search for, and use of Wellness Program information
• Effective counseling and patient education for behavior change
• Content of public health messages and community campaigns

Effective health communication should have these attributes:
• Accuracy: content is valid and error-free
• Availability: delivered or placed where the intended audience can access the information
• Balance: content presents benefits and risks of potential actions
• Consistency: content is locally consistent over time and is also consistent with information from other reliable sources
• Evidence-based: content and methods of delivery are based on relevant scientific proof
• Reach: content gets to or is available to as many people as possible in the target population
• Reliability: content source is credible; content is kept up-to-date
• Repetition: delivery of/access to the content is continued over time, to reinforce the impact with the audience and to reach new members of the target population
• Timeliness: content is provided when the audience is most receptive to, or in need of, the specific information
• Understandability: reading, language levels, and format are appropriate for the specific audience (i.e., Employees, Family Members, Garrison leadership, etc.)

What the research says about health communication
• Health communication best supports Wellness when multiple communication methods are used to reach specific audiences.
• Effective Wellness and communication initiatives should reflect an audiencecentered perspective, and reflect the preferred formats, contexts, and means of communication for the intended audience.

Material adapted from: U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000.
http://www.healthypeople.gov/document/HTML/Volume1/11HealthCom.htm

Evaluation of successful Corporate Health Promotion Programs has revealed several primary Wellness Program strategies to increase Wellness Program effectiveness and impact overall Soldier health.

Strategy #5: Using a small number of targeted priorities maintains Wellness Program focus.

• Needs assessment data can be used to identify leading health and wellness needs and also high risk populations.
• Choosing a handful of specific health and wellness needs on which to focus will maximize efficient use of resources.
• Keeping the Wellness Program focus small will avoid duplication of other ongoing company Corporate Health Promotion Programs.

Strategy #6: Use standardized processes whenever possible.

Reduce the amount of variation within your Corporate Health Promotion Programs by standardizing all the processes needed for Wellness Program planning and implementation. For example:
• Use the same spreadsheet format for data collection so that the columns are in the same order. This way you can compare information more easily.
• Reuse the same forms for enrollment and attendance. Change the heading as needed.
• Look at other Wellness Program processes (like registration, evaluation, marketing, etc.). What parts of those processes can be standardized?
• The Wellness and Prevention Initiatives website (http://chppmwww. apgea.army.mil/dhpw/Population/HPPiFunction.aspx) has many standardized Wellness Program resources in a variety of topic areas.

Strategy #7: Wellness Program delivery methods should be flexible and adapted to population needs.

• Delivery of products and services may depend on: company needs, training requirements, other scheduling considerations (such as work/duty schedules, school scheduling, etc.), member preference, and/or availability of staff or space.
• Be flexible: the same produce/service delivery methods may not work for every population.
• Some company’s may want services provided to them as close as possible to the company location; other companies may prefer as many services as possible bundled together at once (regardless of location).
• Take wellness and preventive medicine beyond the walls of the organization in order to meet leadership and employee needs. Answer the question: “How can we best help leadership and Employees to fulfill their mission?”

Evaluation of successful Corporate Health Promotion Programs has revealed several primary Wellness Program strategies to increase Wellness Program effectiveness and impact overall Soldier health.

Strategy #1: Communication with leadership is essential
• Assess leadership priorities.
• Report Wellness Program outcomes back to leadership in a timely manner.

Strategy #2: Wellness Program planning must be driven by information.
• Determine specific needs of the target population.
• Focus on the health status of the population as a whole to identify the top health concerns.
• Data should drive decisions regarding which health and wellness needs should be addressed first.

Strategy #3: Use electronic information collection and reporting as often as possible.
• Centrally collected information in an electronic format is essential for determining population health and wellness needs.
• Electronic reporting is also very valuable when communicating Wellness Program outcomes to leadership and other stakeholders.
• Flexible reporting capabilities allow information to be presented as information that can support decision-making, in formats that decision-makers prefer.

Strategy #4: Multidisciplinary collaboration enhances employee health and maximizes available resources.
• Collaboration between health disciplines increases effectiveness of Wellness and preventive medicine initiatives.
• Don’t forget to look outside the organization for collaboration partners.
• Optimized Wellness Program outcomes can be met by coordinating the activities of medical experts, cadre, community agents, and funding sources.
• Bundling services together also provides the additional benefit to units by conserving training and mission time.
Implementing these strategies can improve Wellness Program effectiveness and optimize available resources.

Changing health-related behaviors is a difficult challenge. Incorporate the tools below into your Wellness initiatives to assist members in successfully changing health behaviors.

Tool #1: Set effective goals
• Focus on areas that can impact the overall goal.
• For example, if the overall goal is to lose weight, the most productive areas to focus on are the activity and dietary changes that will lead to long-term weight loss.
• For example, stress management and improving self-esteem may also impact weight loss; however, improving relationships, while a worthy topic, will not necessarily impact weight loss.
• Make the goals specific, attainable, and forgiving. For example:
• “Exercise more” is too general.
• “Walk five miles everyday” is specific, but may not be attainable.
• “Walk 30 minutes everyday” is specific and more attainable, but is not very flexible.
• “Walk 30 minutes, five days a week” is specific, attainable, and forgiving.
• Use a series of short-term goals to achieve the ultimate goal.
• Short-term goals break big challenges into more easily attained pieces.
• Smaller steps also provide Wellness Program members with encouragement and success. These small successes are essential for maintaining motivation towards a long-term goal.

Tool #2: Increase self-awareness
• Self-monitoring is useful for tracking behavioral and environmental cues that trigger a particular behavior.
• Keeping track of behavior status is also useful for times when progress towards a goal is difficult to measure, or when an individual is in a maintenance stage.

Tool #3: Offer rewards and motivation
• Encourage members to reward themselves for achieving small successes on the way to their ultimate goal.
• Remember that rewards don’t always have to be “things.” Words of encouragement and praise can provide powerful motivation when spoken by a teacher, instructor, parent, friend, etc.

Tool #4: Respond effectively to set-backs
• behavior change is conceptually a continuum. However, movement along that continuum is not just in one direction. People can move backwards or forwards or sometimes just stay put. Communicate to members that set-backs, lapses and even staying the same (i.e., maintenance) are common for individuals trying to change behavior.
• Stress is often a factor in lapses and relapses. Offer a variety of stress management resources to help members better handle the stress which could trigger a set-back.
• Brain storm to create a list of potential (and probable) obstacles to member behavior change. Then formulate strategies to meet each of those challenges.
• Enhanced time management and decision-making skills can be effective ways to overcome behavior change relapses.
• Offer members with information regarding the behavior change process so that they will be better prepared for the challenges they will face. A brief overview of the Stages of Change may be helpful.

The majority of organizations do not have the Wellness Program resources to address all of their health and wellness needs at once. Priorities must be set to determine the most pressing health and wellness needs. Use the steps below to prioritize company Wellness needs.

Assess the health and wellness needs of the population.

Collect information about the health and wellness needs in the community. How?

• Community- or target group-specific surveys

Identify health and wellness needs and at-risk populations.

Use the information to identify leading health and wellness needs and also high risk populations. For example:
• Obesity and overweight
• Injury prevention
• Self care

Reduce the list.

Not every health need can (or should) be addressed. Use the following questions to determine which health and wellness needs should be addressed first.
• How does the health need impact operational readiness? How big is the impact?
• What are the Senior Management priorities? How does the health need fit into those priorities?
• What are the behavioral factors affecting the health need? What is the proof that a behavior change will make a difference? Has the behavior been successfully changed by other Corporate Health Promotion Programs?
• What other social, physical, or environmental factors influence the health need or the target population?
• Is the health need a greater problem at the local level than in the U.S. population as a whole?
• Does the organization have the subject matter expertise and resources to address the health need?

Develop Wellness Program recommendations.

Only a handful of specific health and wellness needs should be focused on in a given year. Keep the following in mind as recommendations are developed as to which specific health and wellness needs will be addressed:
• Avoid duplication of other ongoing Corporate Health Promotion Programs whenever possible. Identify Corporate Health Promotion Programs already addressing the health need and/or the target population.
• Identify and assess available resources. Build on existing services whenever possible.

Use the recommendations to offer tailored, targeted, integrated initiatives to address the prioritized list of health and wellness needs. Prioritizing health and wellness needs will keep Corporate Health Promotion Programs focused, maximize efficient use of resources, and align Wellness efforts with Senior Management goals and priorities.

References
• US Department of Health and Human Services, Planned Approach to Community Health, http://www.cdc.gov/nccdphp/publications/PATCH/index.htm.
• Implementing a Comprehensive Community Wellness and Well Being Program, presentation by CHPPM-EUR at the 2006 Force Health Protection Conference

Keeping the bottom line up front Bottom Line Up Front in Wellness Program will help you get and sustain Senior Management support. A Bottom Line Up Front approach will also help you more realistically measure the impact of your Corporate Health Promotion Program.

The bottom line in Corporate Health Promotion Programs answer two primary questions:

• How will member health be enhanced?
• What’s in it for Senior Management?

The ultimate bottom line: all roads should lead to readiness.
• Always be ready to communicate to leadership the ways that your Wellness Program impacts readiness.
• Think like Senior Management: what Wellness Program outcomes will be important from a Senior Management point of view?
• Develop line-centered language that communicates those outcomes.
• Ask members how they think a particular Wellness Program enhances force readiness. This input is a valuable source of information.

Use the following steps as a Bottom Line Up Front approach to Corporate Health Promotion Programs.

Step 1: Think about the end of the Wellness Program first and plan backwards.
• It has been said, “If you don’t know where you’re going, any road will get you there.”
• Before planning or beginning any part of the Corporate Health Promotion Program, be able to answer the questions: how will member health be enhanced? What’s in it for Senior Management?

Step 2: Identify concrete Wellness Program outcomes.
• Identify up front what the Wellness Program is working towards.
o For example: will members lose weight? Walk more steps? Decrease injuries? Move to another stage of change?
• Identify any processes or procedures that will be enhanced.
o For example: which pharmacy operations will become more efficient? How will record-keeping be streamlined?

Step 3: Determine what will be measured to show that Wellness Program goals were met.
• Consider what information is really needed to show Wellness Program effectiveness. Avoid the temptation to collect every possible piece of data. Choose a handful of important information points and stick to those.
• Think backwards when determining what information to collect – consider how easily follow-up information can be collected when a Wellness Program ends. Getting follow-up information is often a challenge.
• Only collect information for health behaviors or indicators that the Wellness Program actually affected.
o For example: if the main Wellness Program goal is that members will walk more steps, then it may be better NOT to choose changes in cholesterol level as a Wellness Program outcome (unless the Wellness Program specifically addresses cholesterol).
• Avoid measuring outcomes that the Wellness Program cannot (or did not) affect.

Step 4: Determine what Wellness Program elements must be included to move members towards the Wellness Program goals.
• The concrete Wellness Program outcomes identified in Step 2 are the compass for keeping the Wellness Program on track. All Wellness Program elements should lead towards that ultimate goal.

Working backwards when planning and beginning Corporate Health Promotion Programs is really forward thinking. Keeping the bottom line up front is a smart approach to Corporate Health Promotion Programs.

Health Information Technology can make the entire health care system more effective and efficient by enhancing:

• Documentation (lab and test results, clinic notes, consult recommendations)
• Communication (provider to patient, provider to provider)
• Information input (templates to facilitate data entry)
• Delivery of care (documenting all patient-provider interactions in a single system)
• Chronic disease risk identification (evaluation of risk factors, recommendations for appropriate preventive services and screenings)
• Consistent recording of correct billing codes

But, adapting to Health Information Technology is a challenge.
• Health Information Technology almost always involves a “new system.” Consequently, the entire staff, from health care providers to IM/IT personnel is on a learning curve.
• Existing IT infrastructure may not be adequate, so the Health Information Technology system may be very slow, or may frequently crash.
• The new system may not have all the forms you need already in place. New forms may be needed.

Lessons learned from Health Information Technology implementation

Take advantage of as many training opportunities as possible.
• Learn as much as you can about the Health Information Technology that you need to use. Become an expert.
• Ask questions if you are unsure how to navigate the system.

Keep the big picture in mind.
• Be aware that those keeping the Health Information Technology system up and running may have a very different set of priorities. The IM/IT staff may not see your request as a priority when it is taking all their manpower to trouble shoot the new system each day.
• Other changes to the Health Information Technology system may be in line in front of yours, so be patient.

Think through changes thoroughly.
• Take time to think through a new form thoroughly. Know exactly what you want before talking to the developer.
• Don’t think in a vacuum. If you build a form, make sure it is one your staff will use and find efficient.
• Create a draft version of the form and use it before requesting that it be put into the new system.
• Be prepared to build a good case for why your form should be created. Build a stronger case if your form should be developed ahead of other requests in the queue.
• Be patient and persistent when working with a programmer/developer on a new form. Meet frequently and set up timelines and deadlines.
• Coordinate with IM/IT and the Health Information Technology contractor to see if they can support a new project in the necessary time frame.

For more information about Health Information Technology implementation, go to the Agency for Healthcare Research and Quality (AHRQ) National Resource Center for Health Information Technology at http://healthit.ahrq.gov.