December 5, 2011 Washington, DC. Nico Pronk, Ph.D. HealthPartners Health Promotion Department HealthPartners Research Foundation

Transcription

1 Addressing the Value Proposition of Worksite Health Promotion IOM Committee on Valuing Community-Based, Non-Clinical Prevention Policies and Wellness Strategies December 5, 2011 Washington, DC Nico Pronk, Ph.D. HealthPartners Health Promotion Department HealthPartners Research Foundation Harvard School of Public Health

2 Questions to be Addressed How can worksite health promotion programs optimize the likelihood that employers find value in them? How can program design elements be identified and utilized that are informed by evidence of effectiveness? What kind of simple methods can be deployed to support implementation practitioners in monitoring program impact (and value)?

3 Agenda Making decisions based on evidence Moving beyond limitations of available evidence Practice and Research Connected model Design for outcomes Framework for action Practical reality of practitioners Simple method for monitoring programs Discussion

4 What Works? What is the evidence that shows interventions can Effectively reduce health risks at the workplace Reduce healthcare costs Increase productivity Improve morale Optimize employee engagement? What are the best practices and essential elements of interventions to reduce health risks?

5 Recommendations for Assessment of Health Risk with Feedback (AHRF) from the Community Guide AHRF includes both health assessments and biometric screenings The Task Force finds insufficient evidence to determine the effectiveness of AHRF when implemented alone The Task Force recommends the use of assessments of health risks with feedback when combined with health education programs, with or without additional interventions, on the basis of strong evidence of effectiveness in improving one or more health behaviors or conditions in populations of workers

6 Workplace Wellness Programs Reduce Costs ROI LITERATURE REVIEW Systematic review and metaanalysis Conclusion: Worksite health promotion programs can generate positive ROI for medical-and absenteeism-related savings: medical: 3.27 : 1 absenteeism: 2.73 : 1

7 Workplace Wellness as a Strategic Business Imperative Companies across a variety of industries report benefits: Lower health care costs Greater productivity Higher morale ROI can be as high as 6:1 Six Essential Pillars for Successful Programs: 1.Engaged leadership at multiple levels 2.Strategic alignment with the company s identity and aspirations 3.A design that is broad in scope and high in relevance and quality 4.Broad accessibility 5.Internal and external partnerships 6.Effective communications

8 Program Design Essential Elements of Successful Programs Organizational Culture and Leadership 1. Develop a Human Centered Culture 2. Demonstrate Leadership 3. Engage mid-level management Program Design 4. Establish clear principles 5. Integrate relevant systems 6. Eliminate recognized occupational hazards 7. Be consistent 8. Promote employee participation 9. Tailor programs to the specific workplace 10. Consider incentives and rewards 11. Find and use the right tools 12. Adjust the program as needed 13. Make sure the program lasts 14. Ensure confidentiality Program Implementation and Resources 15. Be willing to start small and scale up 16. Provide adequate resources 17. Communicate strategically 18. Build accountability Program Evaluation 19. Measure and analyze 20. Learn from experience TOTAL WORKER HEALTH

9 Moving Beyond Available Evidence Evidence of what works needs to be applied in the context of the workplace environment Inflexible focus on program fidelity may limit adoption of programs with sustained success Practice-based evidence can only be generated if solutions are successfully implemented Worksite health promotion programs will only deliver on their promise when supported as a business strategy with leadership support and accountability Successful translation of available evidence into practical solutions is paramount

10 Knowledge Translation From efficacy research to effectiveness research to practical applications Research-informed practice to evaluation, action research, or participatory research to new hypotheses generation Practice-informed research

11 Research-Informed Practice Path Efficacy Research Systematic Reviews RE-AIM Effectiveness Research Observing Summarizing Reflecting Translation Curve Sensing Presencing Standardizing Piloting Prototyping Drafting 4-S Practice Implementation Process CQI, TQM, Six Sigma, PDSA Research Hypothesis Generation Action Research Spirals Participatory Research Practice-Informed Research Path

12 Practice and Research Connected Translation of researchbased learnings into practical solutions Translation Curve

13 Translation Curve Observing Standardizing Summarizing Piloting Reflecting Prototyping Sensing Drafting Presencing

14 Observing Standardizing Seeing reality with a new set of eyes. Objectively Summarizingaccessing what is Piloting known using tools and techniques that reflect current evidence; not merely gathering information Reflecting Prototyping that confirms preexisting assumptions. Being open to absorb available knowledge and information Sensing in a non-judgmental Drafting way. Presencing Translation Curve

15 Translation Curve Observing Summarizing Reflecting Sensing Standardizing Taking stock of what is known about Piloting a specific topic in the context of program structure, process, and outcomes. Prototyping This step includes the identification of knowledge Drafting gaps. Presencing

16 Translation Curve Observing Standardizing Summarizing Reflecting Sensing Contemplating and Piloting uncovering the meaning of what has been observed. In so doing, Prototyping uncovering the possibilities and intention of what may need to be done in Drafting order to generate a new solution. Presencing

17 Observing Summarizing Reflecting Sensing Presencing Translation Curve Standardizing By considering the potential solution as part of a new Piloting mental model or paradigm (rather than reflecting in the context Prototyping of mental models that are based on past experience), Drafting an emerging new purpose, will, and ideas for action are uncovered.

18 Observing Standardizing The point at which there is a recognition of what the solution will be like. Summarizing The vision of what needs Piloting to be created presents itself and clarity of purpose Reflecting initiates the emergence Prototyping of the new reality. Presencing reflects the point at which the future emerges into Sensing Drafting the present. Presencing Translation Curve

19 Translation Curve Observing The first step in building the practical solution as Summarizing the team creates the new reality by sharing their plans, Reflecting thoughts, and ideas. This step generates the blueprint Sensing for the new application. Standardizing Piloting Prototyping Drafting Presencing

20 Translation Curve Observing The first attempt at building the solution so it Summarizing can be tested, improved upon, and prepared for initial Reflecting market-readiness. Lots of customers and consumer insights are Sensing gathered at this stage. Standardizing Piloting Prototyping Drafting Presencing

21 Testing Observing of the most promising prototype(s) in a real-world situation that is highly Summarizing reflective of the marketplace in which this practical solution Reflecting has to perform. This stage allows for final adjustments to the product Sensing prior to full production. Presencing Translation Curve Standardizing Piloting Prototyping Drafting

22 Translation Curve Observing Standardizing Full implementation of the new solution in the market according to a newly Piloting created or established method and process that is Reflecting routinely followed Prototyping optimize performance and reduce variance in outcomes. Summarizing Sensing Drafting Presencing

23 Translation Curve Tools Observing Systematic Reviews Summarizing Standardizing Piloting RE-AIM Reflecting Sensing Drafting Prototyping 4-Ss Presencing

24 Practice and Research Connected

25 Comprehensive Evidence-informed Person-centric 4 Steps of Simple Design 1. DESIGN Participation Satisfaction Willingness to refer 2. EXPERIENCE Modifiable behavior Quality of life Human performance 3. HEALTH & PRODUCTIVITY Reduced Utilization Productivity improvement Cost-effectiveness 4. ROI

26 Generating Value for Stakeholders Possible Simple Socially rewarding Make Being Healthy and Productive Financially rewarding Personally relevant Organizationally relevant Community connected Levels of Influence Individual Interindividual Organizational Environmental Exceptional Customer and User Experience Outcomes Health Productivity Financial / ROI Source: Pronk, NP. Journal of Physical Activity and Health, 2009, 6 (Suppl. 2), S220-S235.

27 Practical Reality Simple methods are important in day-to-day program implementation and administration Focus on most meaningful and impactful factors Population definition Penetration Implementation Participation Effectiveness Population health impact may be positioned as the multiplicative result of four distinct impact measures Impact measures are integrally related if any one measure equals zero, total impact equals zero

28 The PIPE Impact Metric Penetration The proportion of the target population that is reached with invitations to engage in the program or intervention Implementation The degree to which the program has been implemented according to its work plan Program Investments Participation The proportion of invited individuals who enroll in the program according to program enrollment and tracking mechanisms Effectiveness The rate of successful participants Success may be defined in multiple ways, e.g., number of individuals meeting a certain standard or threshold, number of steps per day compared to baseline, etc. Program Returns

29 PIPE Impact Metric Example Population Health Impact = (Penetration)(Implementation)(Participation)(Effectiveness) Worksite walking program Population = 10,000 employees Penetration: 98% received program invitation (9,800/10,000) = 0.98 Implementation: 85% of work plan successfully implemented 85% = 0.85 Participation: 1,666 employees enroll in the program (1,666/9,800) = 0.17 Effectiveness: 750 employees met success criterion (750/1,666) = 0.45 Program Impact: (0.98)(0.85)(0.17)(0.45) = = 6.37%

30 References Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Affairs (Millwood). 2010; 29(2). Published online 14 January Berry LL, Mirabito AM, Baun WB. What s the hard return on employee wellness programs? Harvard Business Review 2010 (December);88(12): NIOSH Essential Elements List (see Pronk NP. Practice and research connected: A synergistic process of translation through knowledge transfer. In: Pronk NP, Ed. ACSM s Worksite Health Handbook, 2 nd Edition. Human Kinetics, Inc. Champaign, IL, Pronk, NP. Physical activity promotion in business and industry: Evidence, context, and recommendations for a national plan. Journal of Physical Activity and Health, 2009, 6 (Suppl. 2), S220-S235. Pronk NP. Designing and evaluating health promotion programs: Simple rules for a complex issue. Disease Management & Health Outcomes 2003;11(3): What works in worksite health promotion. Systematic review findings and recommendations from the Task Force on Community Preventive Services. American Journal of Preventive Medicine 2010 (February);38(2) Suppl 2.

31 Thank You!