Covering All the Bases: A Holistic Approach to Healthy Outcomes

At the Ninth Annual Healthy Outcomes Conference in April 2010, topics for discussion included chronic disease prevention, best practices and case studies presenting results.

The Silent Thief—Understanding the Impact of Osteoporosis and Low Bone Health

Dr. Marla Shapiro, associate professor, Department of Family and Community Medicine at the University of Toronto

Osteoporosis affects approximately 1.4 million Canadians and one in four women over the age of 50. The major complication of osteoporosis is the occurrence of fragility fractures, a fracture resulting from a fall from standing height or less. Osteoporotic fractures are common; the annual number of fractures exceeds the number of heart attacks, strokes and breast cancer combined. The overall incidence of fractures increases with age in post-menopausal women.

Osteoporosis is not just a disease of the elderly. While the incidence of fractures for women ages 50 to 64 is lower compared to older women, a higher percentage of these fractures are non-hip and non-vertebral fractures, which negatively impact one’s ability to perform the basic duties of employment. Wrist fractures, the most common fracture in younger women, have a substantial impact on physical functioning—driving, typing, dressing, etc.

The prevalence and cost of osteoporosis are expected to increase as the population ages, and people are staying in the work force longer. The annual direct costs of treating osteoporotic fractures of people in the workplace are estimated to be $1.9 billion in Canada.
Osteoporotic fractures significantly impact quality of life and result in considerable morbidity and even mortality. Of patients who sustain a hip fracture, one year after the fracture, 80% are unable to carry out at least one independent activity of daily living, 40% are unable to walk independently, 30% have permanent disability, and 20% die. This may have an impact on employee absenteeism and disability in the workplace for those who suffer a fracture and for those who are care providers. Compared to other chronic medical conditions, such as chronic obstructive pulmonary disease, diabetes and heart disease, osteoporosis leads to greater reductions in health-related quality of life.

Your Health Matters – Workplace Cancer Prevention and Screening Program

Elizabeth Dulmage and Nicole Robinson from the Erie St. Clair Regional Cancer Program presented an overview of a workplace intervention program and research project that has been piloted through select employers across Canada

The Erie St. Clair Regional Cancer Program has designed a unique and innovative workplace health information/education and cancer screening referral program called Your Health Matters (YHM). The program includes a brief personalized intervention strategy designed to motivate employee interest and investment in prevention and screening behaviours. The program was offered via facilitated in-person sessions (in the workplace) or an e-learning module. Pan-Canadian and bilingual program materials were developed in consultation with many partners, including cancer agencies from several provinces, public health units and the Canadian Cancer Society. Materials included an information booklet and a personalized “risk tracking card” (modifiable risk factor status and cancer screening participation). A strategic focus of the program was to link participants with follow-up programs and services (i.e., healthy weight and physical activity programs) available in their workplace or community.

The program’s success has resulted in the development of a unique and innovative public/private partnership with Canada’s Corporate Roundtable on Cancer Control.

The YHM presentation highlighted program partnerships, goals and key pilot outcomes, including:
• increased cancer screening participation;
• increased participation in workplace support programs available;
• increased follow-up on personal risk with primary healthcare providers; and
• improvements in participants’ modifiable risk factor status.

The presentation also highlighted next steps in program development, including the development and implementation of a healthy workplace assessment/support tool to initiate healthy workplace policy and to drive sustained change at the workplace level. In its next iteration, the program will also strive to incorporate an outcome-based return-on-investment model.

Measuring and Benchmarking Outcomes

Dr. Peter Melnyk, associate director, research application, BioMedCom Consultants, and Allan Smofsky, workplace health strategist

A review of the biomedical literature and other publicly available sources of information on the topics of health and disease management in Canadian workplaces was recently conducted. The main purpose was to identify best practices and key clinical, humanistic and economic outcomes measured in workplace health and wellness evaluation.

The review found a number of inconsistencies between established best practices and how organizations approach their health and wellness programs.

Some studies report that—to be truly effective—a workplace health or wellness program must consider the work culture and appropriate organizational and policy changes, yet much of the past focus of such programs has been limited to general health education and awareness of one’s health issues.

Employers are increasingly placing emphasis on employee health and well-being; however, many of today’s workplace health or wellness programs lack the programmatic rigour to generate meaningful health outcomes.

Program evaluation is a key component of long-term success, yet many plans do not measure the impact of workplace health or wellness programs on such key outcomes elements as health risks, health/benefits costs, employee engagement, productivity, etc.

As the cost of employee health and benefits programs continues to rise, however, leaders have begun to take more notice, and some organizations are beginning to look at ways to more effectively manage long-term plan costs. At the same time, there is growing realization that traditional approaches to managing an organization’s health/benefits costs such as increasing health plan deductibles, raising employee contributions, tightening absence management procedures, etc. are not the answer. Such cost management techniques fail to address the root causes of benefits costs—the health of the organization’s employees—and are, therefore, not sustainable.

Organizations should measure and analyze their health/benefits costs and, moreover, seek to link these to broader organizational metrics such as engagement, customer loyalty and financial performance.

As employee health and wellness increasingly becomes an integral part of an organization’s way of doing business, we can anticipate a heightened emphasis on the evaluation and generation of outcomes, and the linking of health indicators to key organizational metrics. Health and wellness resources, programs and initiatives—and people—will, therefore, be challenged to demonstrate meaningful results or run the risk of becoming superfluous over time.

“Hey, This Ain’t the Wild West!”: Respect @ Work

Sharon Bar-David, Bar-David Consulting Inc.

When it comes to respect in the workplace, many organizations suffer from blindness, inaccurate diagnosis, ill-equipped managers and an inability to act. Unfortunately, these problems have far-reaching effects.

Behaviours can be classified into various categories of severity: incivility, harassment, bullying and physical violence. Sharon Bar-David’s presentation focused on the two that are least understood and most commonly mishandled: incivility and bullying.

Incivility comprises small acts of rudeness and disrespect that are very common in most workplaces. While most organizations do nothing about incivility phenomena, new research demonstrates that small actions such as not saying good morning, ignoring or excluding someone or gossiping have far-reaching ramifications to business outcomes. For example, when the person exhibiting inappropriate and unprofessional behaviour is in a position of authority, one in four workers on the receiving end of the incivility responds by reducing his or her work effort, and one in two will contemplate changing jobs.

Bullying, on the other hand, is characterised by persistent, intense “negative acts”, where the target feels unable to defend himself. Bullying does not necessarily have to be intentional. Its effects on the victim and on bystander colleagues are typically devastating, and extended sick leaves are often present. A U.S. study shows that bullying victims suffer from severe anxiety (76%), disrupted sleep (71%), loss of concentration (71%), post-traumatic stress disorder (47%), clinical depression (39%) and panic attacks (32%), and most of the symptoms began only after the bullying began. These symptoms have obvious implications for safety, customer service, innovation, teamwork and retention of talent.

When it comes to both incivility and bullying, here are four commandments organizations should follow.

1. Demand that leaders model the right behaviour and treat it as a serious matter if they don’t.
2. Build leaders’ capacities to diagnose and respond to respect-related issues through training and ongoing support.
3. Handle complaints seriously and swiftly. When in doubt, access internal or external experts who understand the unique dynamics of incivility, harassment and bullying.
4. When it comes to incivility, address problems even when they seem small and inconsequential.

Mission in Action at Canadian Pacific

Sylvana Leclerc, wellness coordinator, Canadian Pacific Railway

As a federally regulated transportation organization, Canadian Pacific Railway (CP) must comply with well-defined and measurable health and safety regulations. Having a clear and integrated vision for employee wellness is the key not only to meeting these responsibilities but to ensuring CP’s workforce is ready to meet future growth and opportunities. With about 15,000 employees in Canada and the U.S., multiple work locations and functions, some remote locations, shiftwork and an aging population, CP has no lack of challenges. In its 10-plus years of existence at CP, wellness has gone through several evolutions. Health prevention is still a fairly new field. CP’s wellness mission—to recognize employee health as a business driver, promote healthy workplace culture and value and reward healthy behaviour—is helping guide action plans at every level of the organization.

Integrating wellness in the CP culture it is closely linked to the established safety structure. Wellness is driven by senior management and union committees, but the implementation is grass roots, engaging health and safety committees and wellness leaders at the work site level.
I am often asked, How do you sell wellness to management? One tip is to make management aware of the program’s successes and how these are in line with business strategies. Through periodic reports, senior leaders learn why health risk factors and event participation are important to future health costs, what this means for the employer and how it relates to disability rates, employee engagement and presenteeism. By integrating wellness initiatives with existing events and processes, CP has been able to secure funding, provide value and grow progressively over the years.

To measure wellness successes we initiated the design of a wellness scorecard. It is evolving along with the program. We include multiple risk factor rates from biometric screening initiatives, access and participation rates and a self-care index, which reflects employees’ self-efficacy and readiness to make changes and take action. Our goal is to help employees make healthy choices daily by providing a healthy work environment and work culture and some resources and opportunities to minimize barriers to change. We do this through several initiatives, including health screening and flu vaccination clinics, telephone health coaching programs, health risk appraisals, education and training, and healthy habits initiatives and challenges. Employees also have access to a wellness subsidy.

As with many organizations, CP is looking at significant retirement and changes in its demographics in the next
few years. Its wellness strategy is crucial to helping define its culture and the health of the organization.

Case Report
A working case scenario: What would your dream team do?

This year’s Healthy Outcomes Conference included a session that put attendees to work solving a fictitious—yet timely—case study. Formed into groups, delegates formulated innovative solutions to a corporate wellness problem. With a strong showing of unique ideas from every table, ultimately, the winners were:

Nickey Alexiou, vice-president, HR, Heart and Stroke Foundation
Carla Anglehart, director, organizational development, Health Association Nova Scotia
Charles Bruce, CEO, Nova Scotia Public Service Long Term Disability Trust
Jill Doucette, senior manager, pension and benefits, Kraft Canada
Carmen Hogan, director, business development, Sun Life
Leanne MacFarlane, senior director, business development, MHCSI-Managed Health Care Services Inc.

The Problem
Nerds Inc. is a software company headquartered in Windsor, Ont. Most of Nerds Inc.’s employees work out of the Windsor location, but there are also two satellite locations in Vancouver and Halifax.

Because of the downturn in the economy, Nerds Inc. is running a shortfall of $1,500,000. Nerds Inc.’s workforce has been cut from 5,000 to 4,000 employees in the Windsor location, and the satellite offices have seen their staffs cut from 200 to 50. Employees in the Windsor office are mainly men in the age range of 20 to 35 and they vary in terms of culture and religion. Most of the company’s programmers (who make up the bulk of the employees) prefer to work long hours, starting late in the day and working until the wee hours of the morning.

Nerds Inc. is in a highly competitive market for university graduates and uses its health and wellness program as a retention/attraction tool.

That program currently includes:
• 100% benefits coverage for medical and 90% for dental;
• short- and long-term disability benefits and an employee assistance program (EAP);
• a subsidized cafeteria and a nap room in the Windsor office; and
• a flexible workweek where employees can compress their work into fewer longer days, even working overnight in the office.

Company morale is at an all-time low, and many high-performing employees who held on to their jobs through the layoffs are now leaving to pursue employment elsewhere. As well, employee drug claims have risen over the past year, and obesity is becoming increasingly prevalent in the employee population.

Nerds Inc. would like to make some enhancements to the health and wellness program and has hired your team as outside consultants to come up with a plan that will maintain employee wellness, improve retention and job satisfaction, and increase productivity, but at no extra cost over the next three years. What will your Dream Team do?

The Solution
Step 1: Survey/Focus Groups
Establish a baseline. Nerds Inc. needs to understand its employee concerns and determine its opportunities, willingness to change, etc. In order to do so, we will start with a quick survey (sent to employees’ BlackBerrys) and follow up with focus groups for details.

Step 2: Health Risk Assessment (HRA)
Work with current benefits vendors to do an HRA. There may be secondary factors Nerds Inc. is unaware of.

Step 3: Benefits Plan Design
Implement a flex plan with core (company-paid) and enhanced (employee) contributions. Core contributions will reduce the health and dental reimbursement. Since it’s a young group, we anticipate many will not need the current (generous) level of coverage. Provide flex credits and healthcare spending accounts.

Step 4: Nutrition and Physical Health
With costsavings from the flex plan, target physical health and nutrition. Get employees active by putting in a games room (Wii, shuffleboard, darts, etc.), which they can use at break time to get them active and promote socializing with peers. Subsidize healthy options in the cafeteria and provide nutritional counseling under an EAP program. We recommend a lunch and learn (webinars for remote employees) to encourage nutrition counselling.

Step 5: Address Stress and Morale
Work with the EAP provider to develop programs for employees and managers, and ensure that the program offers ongoing support. Encourage the use the of nap room during lunch and breaks so employees can rest, meditate, etc.

Step 6: Communication
The president of Nerds Inc. can roll out initial communications to employees so they know there is support from the top. This is a young group, so we recommend electronic tools such as text, email, BlackBerrys, webinars, teleconferences, etc.

Nerds Inc. needs to be a fun place to work through benefits providers, an EAP, etc. Some easy fitness and nutrition challenges can be rolled out. This is great for employee health but also improves employee social interaction and team morale.

For a PDF version of this article, click here.

© Copyright 2010 Rogers Publishing Ltd. This article first appeared in the June 2010 edition of WORKING WELL magazine.