Peel Workplace Health Network presentation June 4, 2010

1. Generating & Measuring Healthy
Workplace Outcomes
Peel Workplace Health Network
June 4, 2010
Peter Melnyk PhD & Allan Smofsky

2. Agenda
- Emerging definition
- Literature review:
of healthy workplace:
WHP in Canadian
what it means to
worksites
different stakeholders
- Components of
- Measuring healthy - Phase II: employer
Canadian WHP
workplace outcomes survey
programs
- Generating healthy
-WHP program
workplace outcomes:
evaluation
some emerging
opportunities
where are we now? where are we going?

3. Background
 evolution of WHP understanding:
“a marketing process
which produces employee health is a
widespread and combination of
sustained employee personal and worksite
participation in inputs
healthful activities”1
 more comprehensive WHP initiatives need sophisticated management:
 clear objectives and well defined endpoints/outcomes
 robust evaluation of program outcomes
clear positioning/integration of WHP within the corporate culture
1. Wilbur CS Prev Med 1983;12(5):672-81

4. Objectives – Phase I
 Review the biomedical literature and other publicly available sources of
information on the topics of workplace health promotion (WHP) and disease
management in Canada to identify:
 best practices
 key clinical,
 humanistic, and
 economic outcomes measured in WHP evaluation

5. Methods
 most literature was retrieved from a structured PubMed search of peer-reviewed
literature:
screening full text data
PubMed abstracts screening extraction
 approximately 35 studies meeting the search criteria were published and indexed
by PubMed over the last 5 years
other sources investigated: Canadian Association for Population Therapeutics (CAPT)
meeting abstracts, Public Health Agency of Canada

6. General Results I
 The six disease categories reported to incur 70% of an organization’s
benefit costs are:1
 cardiovascular, musculoskeletal, respiratory, digestive, cancer, and stress
 these conditions are preventable or modifiable through behavioural changes
 In Canadian WHP programs, the areas targeted related primarily to:
 cardiovascular health
 general health
 musculoskeletal disorders
 Disease management – absent from the peer reviewed literature..
1. Public Health Agency of Canada. Active living at work - Trends & impact: the basis for investment decisions. 2007.
http://www.phac-aspc.gc.ca/alw-vat/trends-tendances/index-eng.php

7. General Results II
 Key factors that contribute to successful WHP initiatives are:
 targeting several health issues
 integration of occupational health and safety with workplace wellness
 enhanced effectiveness
 employee receptivity
 attaining high participation
 time and access on-site services
 incentives
 integrating WHP into the organization’s culture and operations

8. Workplace Wellness Programs in Canada
 Increasing focus among employers on employee health and well-being
 Much of the past focus of WHP programs has been on education to modify
personal health practices;
 studies reporting that—to be truly effective—a workplace wellness program must consider
appropriate organizational and policy changes
 As many as 91% of Canadian organizations surveyed (N=634) by Buffet
and Company2 in 2009 offered some type of wellness initiative – this is an
increase from 44% in 1997
 many not designed to generate outcomes (e.g. flu shots)
 2010 Conference Board of Canada Survey (N=255):3
 64% of survey respondents agreed that their benefit programs focused on health promotion
and disease management, but…
 only 26% of respondents reported that their organization has fully developed a
comprehensive wellness strategy
2. Buffet and Company. 2009 Wellness Survey.,3. Stewart N. The Conference Board of Canada, 2010

9. Components of WHP programs
offered in Canada
 The most commonly offered elements of WHP initiatives among Canadian employers
include:
 employee assistance programs: 94-97%
•often offered as stand alone measures not strategically
 CPR/first aid training: 84% incorporated as part of a comprehensive WHP approach
•conclusive evidence on the impact of EAP on
 flu shots/immunizations: 78-83% performance is needed
 The least commonly offered components:
 on-site medical care: 19-21%
 24 hour nurse line: 22%
 fitness counseling: 17-22%
 There is variability in the types of components offered in different regions of Canada

10. Program evaluation I
 Collection of program result data is not consistent
 The literature describes a number of reasons for the lack of robust data
collection in the area of employee health:
 many managers simply accept that healthier employees are more
productive
 employee health not consistently managed or monitored by health
professionals
 human resources professionals may not receive training necessary to
interpret and manage employee health and wellness
 resources/tools available
Data on employee health/well-being is typically gathered using a macro
perspective which is difficult to reconcile with the more granular employee
engagement/productivity data

11. Program evaluation II
 Program evaluation is a key component of long-term success; however
detailed measures of WHP program impact on health risks, employee
productivity and costs are often not collected
 Tune Up Your Heart1 – designed with a focus on measurement and evaluation
of health outcomes
 risk assessment; tailor intervention to risk strata
 measurements of systolic and diastolic blood pressure, lipid levels & BMI
 smoking and diabetes status were determined
 pre/post analysis of statistically significant changes in components of risk
 historical data: annual per capita costs for life insurance, absenteeism, STD, LTD
and prescription drugs
 Outcomes:
 components of risk
 risk status
 economic outcomes
1. Chung M, et al. Worksite health promotion: the value of the Tune Up Your Heart program. Popul Health Manag. 2009 Dec;12(6):297-304.

12. Evaluation metrics
 Health & Well-being
 Primary health and well-being outcome measures
used in studies identified in the literature search:
 body mass index
 short term disability
 blood pressure
 cholesterol and triglyceride levels
 self-reported stress level
 smoking cessation rate
 Other metrics?

13. Evaluation metrics
 Economic
 Primary economic/productivity outcome measures used in identified studies:
 absenteeism
 WCB costs
 short-term disability claims
 annual grievances
 Evaluation of WHP success or failure not based on any single metric

14. Defining a Healthy Workplace
Healthy,
Productive,
Successful
Workplaces
Safe & Healthy Work
Environment (Process
AND Culture)

15. Defining a Healthy Workplace
 Safe & healthy work environment includes:
 Process Safety
 Ergonomics
 Physical and chemical hazards
 Emergency response
 Injury prevention
 Disability case management
 Harassment/bullying prevention & management
 Physical environment
 Environmental practices
 Safety Culture
 Assessing cultural contributors to safety performance
 Supervision
 Empowerment
 Teamwork
 Workload

16. Defining a Healthy Workplace
 Personal Health / Lifestyle Practices include
 Physical activity
 Healthy eating
 Healthy weights
 Tobacco use
 Stress management
 Disease management
 Drug and alcohol use
 Immunization
 Preconception health

17. Defining a Healthy Workplace
 Supportive Organizational / Work Culture includes:
 Enshrining importance of employees in org. mission/vision/strategy
 Effectively communicating this both internally & externally
 Developing policies that reflect this
 Management practices; walking the talk! – making people policies ―real‖
 Understanding employee attitudes and perceptions
 Job control and decision making
 Work flexibility; work-life balance
 Notion of "fair work conditions" which occur when:
 Work demands are reasonable
 Effort required is manageable
 Input/decision making is maximized
 Feedback & recognition are adequate
Job satisfaction > Job stress

18. Healthy Workplace – Who Cares?
The Stakeholder Outcomes They Care About
 HR  Engagement, Health costs
 Finance  Positive ROI, Profitability
 Occupational Health  Employee health, Absenteeism
 Operations  Productivity & Performance
 Sales/Marketing/Customer Service  Sales, Customer satisfaction / loyalty
 Executive  Attraction/retention, Profitability, CSR
(enhanced reputation)
 Labour  Member satisfaction, health & well-being
 Each employee  Health/well-being, Stress
 Government  Population health, Labour productivity,
healthcare cost trend
 Community  Contribution to community benefit;
improved community well-being

19. Healthy Workplace Outcomes
Measurement- Guiding Principles
1. Understand your organization’s key issues & cost drivers that impact employee health/well-being
 Determine key benchmark measures & establish baseline
2. Include qualitative measures (e.g. how employees say they manage their health) as well as quantitative
3. Consider both lagging and leading indicators
4. Determine desired objectives/outcomes; establish linkages between outcomes where possible at outset & factor
into evaluation methodology
5. Evaluate at identified milestones on an ongoing basis
6. Standardize and align data requirements across all relevant vendors where possible
7. Compare where possible to relevant norms – Canadian, industry specific, etc.
8. Link to external best practice standards such as BNQ¹/GP2S, NQI, etc.
BNQ¹: Bureau de Normalisation du Québec: BNQ 9700-800 norm: "Healthy Enterprise"
Prevention, Promotion and Organizational Practices Contributing to Health in the Workplace

20. Healthy Workplace Outcomes Measurement -
Lagging Indicators of Health
The ―economic burden‖ of illness and injury –
defined costs spent on events that have already
occurred
 Health & drug claims
 Absenteeism
 Short/Long Term Disability
 EAP utilization
 Accidents
 Turnover
 Productivity
 Profitability

21. Outcomes Measurement –
Leading Indicators of Health (Measuring Risk)
Leading indicators of health are predictive of
health issues and therefore predictive of health
claims and other issues to come
 Physical Activity
 Obesity
 Tobacco Use
 Substance Abuse
 Stress/ Resilience
 Environmental Quality
 Access to Health Care
 Engagement
 Health management attitudes / habits
 Presenteeism
 Customer satisfaction/loyalty

22. Population Health Trends
 Diabetes: Economic burden of Diabetes is currently $12.2bln (2X 2000 level) –
projected to rise to $17bln by 2020 – Canadian Diabetes Association 2010
 Cancer: Costs are doubling every 2-3 years. The model of cancer care is that of
adding-on to existing treatments. Rarely does a new therapy substitute of an older
one. In ON, cancer drugs cost $22.9mln; $79.1mln in 2006 – Report Card on
Cancer, 2007
 Obesity: Employees with BMI>40 vs. recommended weight:
 Lost workdays per 100 FTE’s - 183 vs 14
 Medical claims costs per 100 FTE’s - $51,091 vs $7503
- Obesity and Workers Compensation; Arch Intern Med; Apr. 2007
How many of you measure the impact of diabetes, cancer
and obesity on your organization?

23. Linking Healthy Workplace Outcomes
 Well-being-Absenteeism link: Actual work time lost for personal reasons increased
from 7.4 days per worker in 1997 to 9.7 days in 2006 – Statistics Canada 2007
 Engagement-Absenteeism link (1): For every 100 workers, 47 disability days
reported for ―Very satisfied‖ workers vs. 129 disability days for ―Not at all satisfied‖
workers – Unhappy on the Job, Health Reports 2006
 Engagement-Absenteeism link (2): High-engagement organizations: 6.38
absenteeism days/year per employee; lower engagement organizations: 12.89 days
- Best Employers in Canada, Hewitt 2009
 Wellness- Absenteeism link: Dow Chemical - Of those who participated in
moderate or intense weight management intervention, the average days of lost work
days due to illness decreased from 3.9 days in 2006 to 3.4 days in 2007 - Emory
University Rollins School of Public Health, 2009

24. (More) Linking Workplace Health Outcomes
 Engagement-Well-being link: Sr. mgmt. interest in employee well-being is a key
driver of engagement; however, less than 10% of employees agree that senior
leaders treat employees as vital corporate assets – Global Workforce Study, Towers
Perrin, 2008
 Engagement- CSR link: 53% of employees would take a pay cut to work for an
employer with a reputation for caring about employees and the community – Kelly
Services survey (7,000 employees), 2009
 Wellness-Engagement link: 45% of Americans in small-medium sized companies
would stay at their jobs longer because of employer wellness programs; 40% were
encouraged to work harder and perform better; 26% missed fewer days of work by
participating in wellness - The Principal Financial Group , Well-Being Index, 2009

25. Linking drug and disability data -
an example of a broader outcomes approach
 In a 3-year study of employees with rheumatoid arthritis*, the researchers found that:
 Higher employee out-of-pocket payments may lead to lower medication
adherence
 As members’ out-of-pocket costs increased by $20 above the baseline, there was a
35% decrease in the percent of the population filling at least one prescription
 People who adhered to their medication had fewer incidences and shorter
durations of short-term disability claims
 For members who did not fill a prescription, STD incidence rate was 36%, compared to
23% for members who filled at least one prescription
 Members who did not fill a prescription averaged 5 days longer STD duration than
members who did fill a prescription
* Integrated Benefit Institute, Research Insights- ―The Blind Man and the Elephant” , 2007
Implications for organizations: plan design and pricing decisions must
consider the impact on the full spectrum of programs, taking into account
integrated data and metrics; in the above example, the benefits strategy
would logically include promoting medication adherence

26. GENERATING OUTCOMES

27. Workplace Health & Well-being –
A Continuum & Planning Framework
Well At Risk Chronic Conditions Acute Conditions Catastrophic
E.g., low risk, good nutrition, E.g., inactivity, high stress, E.g., prevalent diseases and E.g., respiratory, strain and Conditions
active lifestyle overweight, high blood chronic conditions sprains, lacerations E.g., severe burns,
pressure, smoker premature infant, head injury
Opportunities for Integrated Prevention/Care Management Interventions
Health Risk Disease
Health Promotion Self-Care Case Management
Management Management
Community-based programs Targeted health risk Patient identification
Self-care triage tool Utilization management
(awareness/prevention) assessment and enrollment
Targeted behavior modification Behavioral and clinical Disease-specific
Immunizations Telephonic//E-consults
(e.g. health coaching) support Case management
Health Screening- Stress/mental health
Care coordination Post- decision support Care coordination
HRA & biometrics management
Community-based programs Occupational health and
Health information resources Address co-morbid conditions Social support
(risk-specific) safety
“Preventable illness makes up approximately 70% of the burden of illness and its associated costs.
Well executed health promotion programs can show savings of up to 20% in the first year.”
- Dr. James Fries, Beyond Health Promotion: Reducing the Need and Demand for Medical Care, 1998
27

28. Impact of wellness interventions -
Compression of Morbidity Theory
Typical
Disease free years
Birth Onset of chronic Approximate
Illness associated with life expectancy
aging - 55 years 80 years
Wellness Intervention
Disease free years
Delayed onset
Birth Approximate
of chronic
life expectancy
disease - 65
80 years
years
Source: Dr. James Fries, MD.

29. Workplace Health & Well-Being –
an Outcomes Framework
Physical Work
Health Metrics Environment Business Metrics
- Absenteeism - Productivity
- Disability - Customer
Physical Health satisfaction
- Healthcare cost •Environment
Leadership/ - Financial
•Health
Performance & •Energy Manager performance
Rewards Effectiveness
Well-being
Psychological
Health Social Health
•Stress •Trust
•Achievement •Fairness
•Control •Connectedness
Personal Growth Working
& Aspiration Relationships

30. Generating Outcomes –
Emerging Opportunities
 Emergence of effective tools to measure costs & identify outcomes opportunities
 Multi-stakeholder collaboration – all workplace health stakeholders
 Employer coalitions
 Employee health/well-being as part of Corp. Social Responsibility (CSR) strategy
 Workplace health common standards & model
 e.g. ON Healthy Workplace Coalition
 Certification – GP2S, NQI, etc.

31. Generating Outcomes –
(More) Emerging Opportunities
 More wellness offerings by mainstream workplace health service providers - but often
not seamlessly linked to core offering (e.g. Life/health carriers – wellness/prevention)
 Need greater integration of traditional services (e.g. proactive referral of STD/LTD claimants
to EAP)
 Need greater integration of new/emerging workplace health/wellness services with each
other AND with existing services (e.g. synch HRA and biometric screening initiatives and link
results with flex benefits enrollment process)
 Measure societal impact of workplace health initiatives (e.g. utilization of public health
resources)
 Can help to provide the business case for government to consider incentives for workplace
health improvement

32. Conclusion
 The good news: Considerably greater business emphasis on the importance of
employee health and well-being
 The challenge/opportunity:: Health/well-being to become ―way of doing business‖;
heightened emphasis on evaluation and generating outcomes; health indicators will
increasingly be linked to key organizational drivers
 Caution: Health/well-being resources, programs & initiatives that do not
demonstrably enhance key organizational drivers will become superfluous

33. Phase 2 - Survey
 Several reports have been published with respect to WHP programs
amongst Canadian employers
 Phase 1 reviewed existing WHP literature
 Phase 2 – Employer survey to better understand information on WHP
initiatives that are emerging or otherwise not found in literature review
 This survey and case studies will add to the current body of knowledge by
assessing:
 What health and wellness metrics are used in program evaluation?
 How are health metrics related to specific employee productivity metrics?
 Are WHP programs being developed/modified in response to specific issues
identified through a process to assess employee health issues/needs?
 What is the ROI of given WHP programs?
 Do incentives play an important role in employee participation? Are incentives
evolving beyond awareness towards ―taking action‖

34. Survey – a call to action
 Canadian employers will be asked to participate in the survey starting in
June, 2010
 Learning opportunity: participants will have access to survey results
 The survey as well as background and contact information is available at:
http://www.biomedcom.org/en/whpstudy/

35. • you can take more than one session to complete
the survey; remember to Save before Logging
Out
• when you have completed the survey, check
Survey Completed, click Save, and then
Logout

36.  If you have any questions concerning the WH survey or any aspect
of this presentation, please contact Peter or Allan at:
peter_melnyk@biomedcom.org
asmofsky@cogeco.ca