Caring for the Caretaker: Hospital-Based Worksite Wellness Ideas and Initiatives

Transcription

1 Caring for the Caretaker: Hospital-Based Worksite Wellness Ideas and Initiatives

2 Disclosures No Disclosures

3 Learning Outcomes After this presentation, the attendee will be able to Learning Outcome #1: Demonstrate knowledge of why workplace wellness programs are needed in this country and the benefits that can be gained by both employers and employees. Learning Outcome #2: Describe the process of developing and implementing a successful weight loss/management program in a worksite wellness environment. Learning Outcome #3: Demonstrate knowledge of implementing worksite wellness initiatives for their workplaces (i.e. changing the food environment or engaging employees in web-based programs).

4 Agenda/Outline 1. Exploring the Work Environment 2. Overview of Worksite Wellness 3. Review of the Literature 4. Worksite Wellness at Memorial Sloan Kettering (MSK) 5. Tips to Start a Wellness Program at your Workplace

5 Exploring the Work Environment

6 Think about your work experience Was your job supportive to your health? Was it easy of difficult to eat healthfully? Was it easy to be physically active? How were your stress levels?

7 Aspects of the Physical Work Environment

8 Aspects of the Food Environment

9 Our work environments affect all aspects of our well-being. Physical Mental & Emotional Financial

10 Special Considerations for Healthcare Workers High risk health related behaviors Lack of self care Reduced quality of life Healthcare workers have high stress Burnout is an occupational hazard Impaired work performance Medical error Wood, J Psych Central.

11 The American Work Environment About 60% of American population is employed The workforce is aging The workplace has become more sedentary Access to energy-dense foods All these factors contribute to chronic diseases Work is identified by many as the leading cause of stress Bureau of Labor Statistics, 2014

12 CDC. Chronic Disease Overview Bodenheimer, T. Health Aff. 2009;28(1): Chronic Diseases and the Workforce 1 in 2 adults has a chronic health condition. Treating chronic disease accounts for 86% of national health care costs. Costs are expected to rise to ~$4.2 trillion by 2023.

13 Worksite Wellness Trivia Which chronic condition does that World Health Organization estimate will be the most prominent disability at work in the next decade: a. obesity b. diabetes Depression c. depression d. heart disease Anderko LM. Prev Chronic Dis. 2012; 9:120092

14 Stress and the Workplace Self-reported data from more than 1.3 million employees indicate that 30% experienced some depression or were in treatment. According to the American Psychological Association, 65% of Americans identify work as a leading cause of stress. Work-related stress is a major occupational health risk, ranking above physical inactivity and obesity. Anderko LM. Prev Chronic Dis. 2012, 9: The American Psychological Association. Coping with stress at work CDC. Using the Workplace to Improve the Nation s Health At A Glance 2015

15 Worksite Wellness Trivia On average, how much money does the US spend on annual medical costs for obesity? A) $58 billion B) $89 $147 billion C) $122 billion D) $147 billion Finkelstein EA. Health Aff (5):w Adult Obesity Facts. Center for Disease Control and Prevention. 2015

16 Cawley J. J Health Econ. 2012; 31: Van Nuys, K. Am J Health Promot May-Jun;28(5): Direct Costs of Obesity Direct Costs: preventive, diagnostic, and treatment services related to obesity.

17 Indirect Costs of Obesity Indirect costs are resources forgone as a result of a health condition. Value of lost work due to: illnesses or disability (absenteeism) lower productivity levels (presenteeism) Van Nuys, K. Am J Health Promot May-Jun;28(5): Harvard School of Public Health. Obesity Prevention Source. Obesity Costs. Strategies to Overcome and Prevent (STOP) Obesity Alliance. Fast Facts: Cost of Obesity

18 Overview of Worksite Wellness

19 What is Worksite Wellness? An organized, employer-sponsored program that is designed to support employees as they adopt and sustain behaviors that reduce health risks, improve quality of life, enhance personal effectiveness, and benefit the organization s bottom line. Berry L Harvard Business Review.

20 What Makes the Workplace Unique? Workplaces by nature offer: Captured audience (~155 million workers) that is multigenerational and diverse Structured communication systems Worksite wellness programs can shift the healthcare paradigm from treatment to prevention Fernandez ID Am J Public Health. 105(10), Fonarrow GC Circulation.131:e480-e497

21 Lifestyle Behaviors and Chronic Condition that Worksite Wellness Programs can Target Tobacco

22 Benefits of Worksite Wellness Programs

23 6 Pillars of Successful Programs Communications Partnerships Accessibility Scope, Relevance, and Quality Alignment Multi-Level Leadership Berry L. Harvard Business Review

24 Multilevel Leadership CEO Wellness Program Coordinator Middle Management Wellness Champions Berry L. Harvard Business Review

25 Alignment Create a culture of wellness In line with company s mission statements and identity Weave it into company environment Carrots vs. sticks Complement to business priorities Berry L. Harvard Business Review

26 Scope, Relevance, and Quality Holistic approach to wellness Individualized High quality, popular, comprehensive wellness program Fun and Engaging Berry L. Harvard Business Review. 2010

27 Accessibility Make it easy for employees to engage Fitness center on-site Tasty and healthy food in the cafeteria, in vending machines and catering Wellness screenings at various times and location Go virtual! Wellness on-line challenges, webinars, intranet Berry L. Harvard Business Review

28 Partnership Use internal resources Outside vendors Berry L. Harvard Business Review

29 Communications Know what works for your employees Utilize different forms of communication Flyers, videos, intranet, new employee orientation Berry L. Harvard Business Review

30 Promotion and Preventive Strategies: Programs walking or weight loss challenges Policies physical activity breaks, mandatory lunch breaks, no smoking policies, flexible work arrangements Benefits Environmental Support Link to Outside Community compensation packages, discounts to health supportive services, incentives healthy food environment in the cafeteria and vending machines, safe stairways health fairs with local venders such as inviting local gyms

31 Benefits of Creating a Culture of Wellness at Work In companies with a strong culture of health: Employees are more likely to engage in healthier behaviors. Some companies have reported better financial outcomes and less employee turnover. Commitment to employee well-being is critical to overall job satisfaction. Anderko LM. Prev Chronic Dis. 2012, 9:

32 Are Workplace Wellness Programs Effective? Let s review the literature

33 Worksite Wellness as Public Health Strategy Topic: Nutrition and Weight Status Objective # 7: Increase the proportion of worksites that offer nutrition or weight management classes or counseling

34 Purpose: to evaluate worksite health promotion studies that target diet, physical activity, or both. Assess and summarize the quality and strength of evidence. 47 studies qualified for the review and included three outcome measures: body mass index (BMI), weight and percent body fat. Anderson American Journal of Preventive Medicine, 37,

35 Findings from Systematic Review 32 studies used intervention strategies that included both information and behavior skill components (32 studies). Only four studies looked at policy and environmental changes in the workplace. Most of the studies involved a white collar workforce that included some employees with overweight or other chronic disease risk conditions. Anderson American Journal of Preventive Medicine, 37,

36 Findings Continued No one focus, diet or physical activity, or combination of both appeared to be better than others in terms of its effect on weight loss. Participants who received more intensive interventions resulted in more positive outcomes. The range of cost-effectiveness estimates from three studies varied from $1.44 to $4.16 per pound of weight loss. In individually randomized controlled trials, results showed that compared with control groups after 12 months, participating employees lost an average of 2.8 pounds (9 studies) and reduced their average BMI by 0.5 (6 studies). Anderson American Journal of Preventive Medicine, 37,

37 Conclusion The authors would recommend worksite programs intended to improve diet and/or physical activity behaviors based on strong evidence of their effectiveness for reducing weight among employees. Anderson American Journal of Preventive Medicine, 37,

38 Some limitations of the studies in the review Ethnicity was not reported Age was not reported in 70% of the studies Socioeconomic data and information of blue-versus-white collar jobs were not reported in 40% of the studies Size of the workplace was not reported in 64% of the studies Anderson American Journal of Preventive Medicine, 37,

39 Images of a Healthy Workplace (Fernandez et al.) RCT of 5 paired worksites Environmental changes in intervention sites Messages focused on energy balance, healthy diet and physical activity Mean BMI decreased by 0.54 (p=.02) in the intervention group and by 0.12 (p=.73) the control group Percent of overweight and obesity decreased 3.7% in the intervention group (p=0.07) and increased 4.9% in the control group (p=.1) Difference in difference of 8.65% (p=.02) between groups Fernandez ID Am J Public Health. 105(10),

40 Images of a Healthy Workplace (Fernandez et al.) Conclusion: Worksite wellness programs may reduce the prevalence of overweight and obesity by minimizing environmental exposure to calorie dense foods and increasing opportunity for energy expenditure. Fernandez ID Am J Public Health. 105(10),

41 Effectiveness of a Workplace Wellness Program for Maintaining and Promoting Healthy Behaviors (Merrill et al.) 3,033 (81.2%) employees in an agribusiness company joined a 2-year worksite wellness program called Reaping Rewards Employees received monetary rewards for engaging in good-health behaviors Clinically significant improvements were seen in those with high BP, high chol, high TG, and high glucose (p<0.001) BMI increased slightly in all participants, but the least in obese employees. The most improved biometric scores were among those with poorest health status at baseline High participatory rate likely due to monetary incentive

42 Web-Based Programs May cost less Decrease burden associated with attendance Allow employees to maintain anonymity Widely accessible to individuals with computer access Offer up-to-date, interactive and individualized content Social support platforms Customizable Behavioral Focused

43 Review of Successful Programs

44 Successful Worksite Wellness Programs With workplace health and wellness programs, companies can sustain their most vital resource their employees by effectively improving employee health, productivity, engagement and well-being, and reducing associated costs along the way.

45 Johnson & Johnson s Wellness Program Employees fill out a Health Risk Assessment (HRA) Identify markers of health and risk factors A representative from an outside company contacts employees and sets up a plan based on results Continual phone consults with a virtual health coach Receiving coaching from diabetes educators Exercising in the on-site gym Joining Weight Watchers At Work Choosing foods with the Eat Complete Program in the employee cafeteria Contact with Employee Assistance Program for stress reduction Fikry, I., American Journal of Preventive Medicne,44(1), S30 S33

46 Johnson & Johnson s Wellness Program Johnson & Johnson's annual average percentage increase in medical and drug costs was 1.0% versus 4.8% experienced by 16 comparison companies. The percentage of employees who exhibit key risk factors has declined significantly: sedentary employees: 39% 20.8% tobacco use: 12% 3.8% high blood pressure: 14% 6.1% high cholesterol: 19% 5.7% Fikry, I., American Journal of Preventive Medicne,44(1), S30 S33

47 Economic Findings Savings of $565 per employee annually Average program cost ranged from $144 to $300 per person. ROI of $1.18 to $3.92 Employees who maintain a healthy weight have average annual medical costs of $285 Employees who gain weight and are at risk for obesity have average annual medical costs of $1,267 Fikry, I., American Journal of Preventive Medicne,44(1), S30 S33

48 RDNs for Chevron Oil Company 45% of all emergencies evacuations were potentially due to cardiovascular disease. The average cost of an evacuation is $49,250 Employees must pass physical tests to ensure they are fit enough to get to the job safely (via helicopter or boat) and react appropriately if an accident hits.

49 Stretch Break

50 Employee Wellness at MSK

51 Who We Are The world s oldest and largest private cancer center Approximately 15,000 employees 30 locations located in New York City, New York State and New Jersey

52 Rationale for Employee Wellness at MSK Invest in preserving our most valuable assets Recruitment and retention of top talent Foster optimal employee health Demonstrate that MSK cares for employee wellbeing Reduce medical care cost trend Improve productivity, reduce absenteeism Provide long-lasting return on investment

53 Employee Wellness at MSK A holistic approach Comprehensive program offerings, i.e.: Lifestyle Coaching; Disease Management; Large Case Management Multimodal Employees & Dependents

54 MSK s Employee Wellness Program Benefits Active Health Management Employee Assistance Program Express Scripts Empire, Blue Cross Blue Shield; Aetna Medical Director Work/Life Weight Watchers Program Coordinator Integrative Medicine 2 Wellness Dietitians RDNs Exercise Physiologist Smoking Cessation Specialist 2 Admin. Assistants Building Resilience

55 One Voice, Multiple Mediums

56 Marketing and Communication Wellness Champions (~300) Departmental meetings/health fairs Cafeteria food demos s: bimonthly newsletter/program listservs Intranet (OneMSK)/external website Print material Center-wide electronic signage

57 Marketing: Wellness Champions Bi-monthly s

58 Intranet OneMSK Community

59 Capturing Impact Why measuring outcomes is important: Justify the value of the program Ways to measure our success: Quantitative - Biometric screening cohort data - BMI data entered by providers into Clinical Documentation information system - Weight Management Pilot Study Qualitative - Employee surveys - Testimonials

60 MSK s Incentive Program Step 1: Health Risk Assessment Step 2: Biometric Screening In 2015, 6,026 employees (37%) participated in the incentive program Height and Weight (BMI) Glucose Blood Pressure LDL, HDL & Total Chol Waist Circumference Triglycerides

61 What We Found: A surprising amount of employees were out of a healthy range for many biometrics that were measured. Self-reported data showed that stress was the top identified condition among MSK employees.

62 Nutrition and Exercise Program at MSK

63 Exercise at MSK Fitness Consultations Lectures Group Classes

64 Role of the RDN Nutrition counseling Presentations Cooking demonstrations Web-based challenges Lunch and learns Small group diabetes education Health fairs Create healthier food environment Present at Stress Management Workshop

65 Number of Employees Nutrition Counseling at MSK New Visit Follow Up Year

66 Nutrition Counseling at MSK

67 Monthly Nutrition Lectures Select a Topic Develop presentation Create Registration Promote event Present Evaluation

68 Lecture Examples What to Expect When You re Expecting Menopause Bone Health Basics Building Strong Bones through Nutrition and Exercise Cultural Foods Workshop Celebrating Minority Health Month Trick Yourself into Losing Weight Eating Clean and Living Green Heart Health Panel

69 National Nutrition Month Events Larger lecture with well known speaker Employee Wellness lecture Employee Success Stories Cooking Demo Weight Watchers lecture Recipe contest Table in the cafeteria

70 Web-Based Challenges WellFit Small Change Challenge Hydration Challenge Fruit and Vegetable Challenge Fit and Festive Walking Challenge Stair Challenge

71 Fruit and Vegetable Challenge

72 Improving the MSK Food Environment

73 MSK FoodWise Program A FoodWise meal is offered daily in the main campus cafeteria Portioned, balanced and affordable Lower in sodium, calories and saturated fat and include a lean protein, vegetable and whole grain

74 Meatless Monday

75 Healthy Hospital Food Initiative (HHFI) Aims to create a healthier food environment in New York City hospitals

76

77 MSK s HHFI Gold Standard Cafeteria

78 Healthy Vending Standards Water and seltzer placed at eye level Higher calorie beverages farthest from eye level and sold in 12 ounce containers or smaller Prohibit advertisements of high calorie beverages on vending machines

79 MSK s Employee Wellness Weight Loss Study 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults Purpose: Intense 6 month intervention designed to help healthcare staff lose weight and improve well-being Acceptance and adherence Average weight loss, average reduction in Body Mass Index, average reduction in waist circumference Additional wellness benefits experienced

80 Tips for Implementing a Wellness Program at your Workplace Collect and present the research Stress the importance of having healthy employees (increased productivity and monetary savings) Assess your work environment Survey employees (determine if there is an interest) Speak to Benefits/Human Resource Department

81 Tips for Implementing a Wellness Program at your Workplace Create a Multidisciplinary Employee Wellness Committee Include a representative from medicine, nutrition, nursing, administration and facility management Establish Wellness Champion Network Develop a newsletter with wellness tips Consider partnering with an outside vender Exercise or meditation classes Discounts on gym memberships Health screening (BMI or body fat) Health fair with local vender

82 Tips for Implementing a Wellness Program at your Workplace Consult with cafeteria management to improve the food environment Contact vending machine company to determine healthy options Highlight healthy meals Hold in-person events with food samples Start small Wellness Signage Department challenges: Biggest loser 10-day web-based challenge

83 Tips for Implementing a Wellness Program at your Workplace Determine time and compensation Split the workload with all interested dietitians Decrease patient load and devote one day to employee wellness Negotiate over-time hours for your time Apply for grant funding Think outside the box Get trained and/or obtain credentials to broaden your scope Other credentials: exercise (personal training, yoga, Zumba, meditation), tobacco cessation, CDE, weight management, lactation consultant

84 Tips for Implementing a Wellness Program at your Workplace Track your engagements and measure your outcomes Keep surveying your employees to make sure they are engaged and that you are meeting their specific needs Remember, you do not have to reinvent the wheel Utilize programs, challenges posters and recipes that already exist

85 Corporate Wellness Articles from Today s Dietitian Worksite Wellness from Today's Dietitian, June 2015 The Rise of Supermarket RDs from Today's Dietitian, October 2014 Workplace Wellness - Companies Make Employee Health Their Business from Today's Dietitian, July 2008 Simple Steps to Take Towards A Career in Corporate Wellness (2011)

86 CDC Worksite Health Promotion Resources

87 Worksite Wellness: Now a Dietetic Internship concentration!

88 In Summary. Unhealthy employees are costly Worksite wellness programs have the ability to improve employee health and reduce cost A comprehensive worksite wellness program is imperative to obtain optimal results RDNs are uniquely positioned and qualified to bring innovative and effective interventions to the growing field of worksite wellness

89 What Questions Do You Have? Nicole Hallissey RDN, CDN IG: WorksiteWellness

90 References Bureau of Labor Statistics. Employment status of the civilian population by sex and age. Available at: Accessed September Coping with stress at work. The American Psychological Association. Published Accessed September Anderko, L., Roffenbender, JS., Goetzel, RZ., Millard F, Wildenhaus, K., et al. (2012). Promoting Prevention Through the Affordable Care Act: Workplace Wellness. Prev Chronic Dis, 9: DOI: CDC. Using the Workplace to Improve the Nation s Health At A Glance Available at: Accessed on September 2016 Bodenheimer, T., Chen, C., Bennet, H Confronting the growing burden of chronic disease: can the US health care workforce do the job? Health Aff;28(1): CDC. Chronic Disease Overview. Available at: Updated February Accessed on September Finkelstein EA, Trogdon JG, Cohen JW, Dietz W Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff.28(5):w doi: /hlthaff.28.5.w822 Cawley J, Meyerhoefer C The medical care costs of obesity: an instrumental variables approach. J Health Econ. 31: Van Nuys K, Globe D, Ng-Mak D, Cheung H, Sullivan J, Goldman D The association between employee obesity and employer costs: evidence from a panel of U.S. employers. Am J Health Promot. 28(5): doi: /ajhp QUAN-428.

91 References Wood, J. (2016). Stress & Unhealthy Habits Can Afflict Health Care Workers Too. Psych Central. Retrieved on September 24, 2016, from Harvard T.H. Chan School of Public Health. Obesity Prevention Source. Obesity Costs. Available at: Accessed on September Strategies to Overcome and Prevent (STOP) Obesity Alliance. Fast Facts: Cost of Obesity. Available at: 0Obesity.pdf. Accessed on: September Berry L, Mirabito AM, Baun WB What s the hard return on employee wellness programs? Harvard Business Review. Published December Accessed July 20, Fernandez, ID., Chin, NP., Devine, CM., Dozier, AM., Martina, CA., McIntosh, S., et al. (2015). Images of a Healthy Worksite: A Group-Randomized Trial for Worksite Weight Gain Prevention With Employee Participation in Intervention Design. Am J Public Health. 105(10), doi: /AJPH Fonarrow GC, Calitz C, Arena R, Baase C, Isaac FW, Lloyd Jones D et. al Workplace wellness recognition for optimizing workplace health. A presidential advisory from the American Heart Association. Circulation. 131:e480-e497. doi: cir Mujtaba, B. G., & Cavico, F. J. (2013). Corporate Wellness Programs: Implementation Challenges in the Modern American Workplace. International Journal of Health Policy and Management, 1(3), Anderson, L. M., Quinn, T. A., Glanz, K., Ramirez, G., Kahwati, L. C., Johnson, D. B. at al The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: A systematic review. American Journal of Preventive Medicine, 37, doi: /j.amepre