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Creating a Culture of Health 2012 IAWHP Global Worksite Health Symposium

Wellness Coach, MD Anderson Cancer Center

Free Powerpoint Templates William B. Baun, EPD, CWP, FAWHP President National Wellness InstitutePage 0 713-745-6927; [email protected]

Surgeon General calls for a healthy and fit nation

America’s Doctor

"I am calling on all Americans to join me in a national grassroots effort to reverse the current obesity crisis. My vision for a healthy and fit nation includes showing people how to choose nutritious food, add more physical activity to their daily lives, and manage the stress that so often derails their best efforts at developing healthy habits."

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A Call to Action: Creating a Culture of Health A bold call to action for hospitals and their employees to be leaders in creating a culture of health American Hospital Association (2010)


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Culture is the personality of an organization ―You see culture in the way the furniture is arranged, what people brag about, what they are rewarded for doing and what they wear.‖ Whitmore (2008) SHRM ―…corporate culture is no longer the relevant topic, I think the relevant topic is macro culture (where different nationalities and occupations play out), and micro cultures where you have problems in the operating room and in teamwork because you have people of different occupations and cultures that all interplay.‖ Edward Schein (2011) Forbes


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Why work at the culture level? Culture is a critical factor in creating and supporting organizational values, directing behaviors, and uniting employees. It is vital in creating value for shareholders, customers, and the communities where these businesses are located. Free Powerpoint Templates

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Organizational culture facilitates • Supports organizational strategy – when strategy and culture reinforce each other, employees find it natural to be committed to the strategy • Employee self management – sense of shared identity and commitment • Stability – sense of continuity and satisfies need for predictability, security, and comfort

• Socialization – internalization of organizational values


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Definition of culture of health ―In a culture of health, employee wellbeing and organizational success are inextricably linked. It aligns leadership, benefits, policies, incentives, programs and environmental supports to reduce barriers to active engagement and sustainability of healthy lifestyles across the healthcare continuum.‖ Baun (2009) http://www.centervbhm.com/lb/workset.html Free Powerpoint Templates

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Culture of health born from years of successful safety cultures Culture of safety is one in which employee behavior is guided by safety procedures, norms, and supports that encourage a safe working environment. Safety behaviors are incorporated into the vision and goals of leadership.


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2011 C. Everett Koop Winners Alcon Laboratories ―With a mission of cultivating a culture of health, Alcon has supported employee wellness since 1993. Beginning with healthy nutrition and fitness activities, Alcon‘s program has since grown and expanded to incorporate a broader set of initiatives coupled with incentives. In 2010, Alcon‘s employees participated in an average of 31 unique wellness activities with 63% completing a health assessment and biometric screenings.‖ Eastman Chemicals "Eastman is honored to receive the C. Everett Koop award in recognition of the company's efforts in building a culture of health," said Edna Kinner, Vice President of Human Resources. "This award not only reflects Eastman's commitment to health improvement, but the significant involvement of Eastman men and women with their personal health."


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2011 C. Everett Koop Winner Prudential Financial ‗With strong statements of support from the CEO and senior leadership, Prudential‘s commitment to a healthy culture runs deep. The organization has developed a well-integrated employee wellness program that offers discounts on healthy food in cafeterias, provides onsite health clinics, as well as exercise opportunities at an onsite fitness center, and works with suppliers to update vending machines with nutritious snacks. By creating a supportive environment and empowering individuals to demonstrate personal accountability for health, Prudential has helped its employees improve their health behaviors.‘


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Climate…the “yeast” in cultural change Three work climate factors when abundant can aid in a smooth shift to a culture that values health & well-being… Allen (2008)

Sense of Community


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Corporate climate factors Shared Vision - Emerges when employees have a chance to integrate their personal goals and approaches with team or organizational goals

Positive Outlook – Drives individuals to look for opportunities rather than obstacles – strengths rather than weaknesses

Sense of Community – Present when employees feel they belong and can trust one another, includes awareness that others care and that we have a responsibility to care for ourselves and others


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Five c’s of culture change • • • •

Comprehension understand the challenge Compassion grow a “spiritual” commitment Collaboration teaming between subcultures Coordination ideation, infrastructure & processes

• Convergence local leadership support & dissemination of new norms Connors & Smith (2011)


SUSTAIN Page 12

Culture of health feeds from bottom up and top down -Perceived as a business asset -Recognized as having a big & important impact to the success of the organization -Leadership participation & encouragement

“Ultimately, company needs to engage people at all levels of the organization to drive a culture of health forward.”

Culture of Health

Catherine Baase, MD Dow Chemical Health Director Employee Benefit News (2012)

-Build a business case for senior management -Illustrate the value proposition to the organization -Pitch a comprehensive program -Build unit level management champions


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Leader ownership = driving commitment down through other leaders The How: • Driven through goal alignment and doing the ―right thing―

• Developing a clear understanding of the interface of facilities, systems, and behaviors • Creating enabling systems that make healthy choice easy • Supporting organizational policies and processes that ensure the effectiveness of enabling systems • Overcoming the helplessness trap


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Engagement important steps in culture change • Engagement for behavior change must first overcome the bias not to change • Choice architecture is how one presents, supports, and influences behavior change and has real impact on engagement • Health literacy and urgency are critical components of engagement • Desired change must be conveyed in words and actions that are relevant to the individuals and meaningful to stakeholders if positive engagement is to occur Nayer (2009) Clinical Therapeutics


Behavior Economics

Overcoming inertia – raising bar on financial discomfort, change get lower costs, don’t change pay more

Social peering – need to look successful

Hyperbolic discounting – you pay if you are not compliant / increase distress overcomes procrastination

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Big steps in creating a culture of health • Establish a sense of urgency • Form a powerful coalition of supporters • Create a vision • Communicate the vision • Empower others to act on the vision • Plan and create short-term wins • Learn from wins, consolidate, create more wins • Institutionalize through building blocks Modified from A Sense of Urgency, Kotter (2008) author of Leading Change, Heart of Change, & Buy In


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Building Blocks of culture that shape long-term behavior change

Norms

Organizational Support Peer Support

Values

Climate Allen (2011)


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Steps to build a culture of health Step Four – Continue to build your formal & informal leadership network & evaluate your progress - Create a human capital team - Engage your wellness committee, champs, & mentors - Engage your external partners (EAP, fitness, benefits, etc.) Step Three – Upon management approval implement the plan

Step Two – Analyze results & consider questions - What do mgt & employees perceive as important - Are there synergies in their perceptions & attitudes - Supports implemented with least resource commitment - Do you need to pilot, if so who will be mgt champion?

Step One – Assess how well your organization supports employee health and well-being - Talk to all levels of management - Conduct observational walk-around - Hold focus groups , world cafes, do cultural audits - Review current HR job climate & satisfaction surveys


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Conducting cultural audits A cultural audit consists of three stages: assessment, analysis and recommendation A S S E S S M E N T

• Review of internal documents • Review of print and other media (radio, TV, newspaper, magazine, web content, etc.) • Make site visits • Hold focus groups • Use surveys • Interview with stakeholders • Design data collection for comparison with a cultural database.


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Cultural Norms ….there is a tendency to believe that behavior is only guided by personal values, however cultural norms guide most health behavior…

Judd Allen Cultural Norms: the accepted and expected behavior of a culture “the way we do things around here.” Norm Gap

Balanced work life Physical activity

Existing Culture

Stress management practice Desired Culture


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Gallup Healthways Well-Being Index Public and private sector leaders use the Well-Being Index to provided real-time measurement and insights to improve health, increase productivity, and lower healthcare costs. USA WellBeing Index

Score

Change

Well-Being Index

66.4

-0.2

Life Eval.

49.6

-0.5

Emotional Health

79.2

-0.5

Physical Health

76.5

-0.6

Health Behaviors

63.9

+0.6

Work Environ.

47.4

-0.2

Basic Access

81.9

0.0 3/01/2012

• Life Evaluation – present life situation & anticipated life situation 5 years from now, etc. • Emotional Health – daily experiences enjoyment, happiness, sadness, anger, stress depression, etc. • Physical Health – sick days, energy, colds, flu, disease burden, etc. • Healthy Behaviors – lifestyle habits: tobacco, eating, exercise, etc. • Work Environment – perceptions of work environment, job satisfaction, trust, treatment, etc. • Basic Access – access to necessities, medicine, enough $, health system, food, water, etc. http://www.well-beingindex.com/


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HERO Employee Health Management Best practice scorecard Since 2006, over 500 companies representing a board spectrum of industries and business sectors have voluntarily completed the scorecard. Senior leadership and corporate culture – 26% very supportive, 45% supportive, 27.5% minimally supportive, 1.5% no support Physical work environment – 59% fitness or walking trails, 74% smoke-free, 61% healthy food, 87% safe work environment, 79% well-lit/accessible stairs, 58% flex time, 73% support early return to work, 45% recognition and reward, 63% wellness activities during the work day


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Culture of health

Woven through our programming in multiple touch point strategies


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Program – big “P” and little “p” Whole Program

Specific Interventions


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O’Donnell – AMSO 30 year quest to synthesize complex literature into a simple , intuitive framework of what works best…..  Benchmark study of 100 best programs  15 years of Koop Awards  375 studies focused on health impact  50 studies focused on financial impact  1,700 AJHP research manuscripts

 Worksites and communities

Opportunity 40% Self confidence Action Skill 25% Support Behavioral efficacy Self efficacy Motivation readiness 30% Knowledge Awareness 5% Modified from O’Donnell (2005) AJHP


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Awareness - Understanding the link between health behavior & health conditions & the benefits of a healthy lifestyle

HRA‘s, Email, Self-Quizzes, Puzzles, Trigger Card, Blogs, Interactive Voice Response, Websites, Lunch-N-Learns, Health Screenings, Health Fairs, Posters………………….…………………………….

Announcements, Bulletin Boards, Pamphlets, Payroll Inserts

Billboards, DVD‘s, CD‘s, Face-to-face Presentations

Repetitive Exposure, Small Increments of Information, Show-Discuss-Apply, Value of Information


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Motivation – embrace people as whole beings, help them discover their life passion and the link between their passion and health and well-being Extrinsic Motivation comes from outside the individual Intrinsic Motivation comes from inside the individual

Used to engage

Shift Produce health behavior change

Engaging individuals in the design & delivery process, targeting & tailoring to meet an individuals readiness to change


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Improving Wellness Using Incentives Incentives should be applied in the context of communications, climate, and culture of an organization Factors that contribute to incentive use success: safe, timely, participant centered, effective, and equitable Simple behaviors – Yes Program participation – Yes Long-term sustained change – Insufficient Evidence Complex change – Insufficient Evidence Terry & Anderson (2011)

Progressive-based Incentives

• Considers starting point of each individual • Risk adjusted rather onesize fits all • Potential to engage those with unattainable health standards • Participant-centered


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Skill – integrating the new changes into one‘s life, more than the why change, also the how, when, where, with whom, and the what if‘s Most Important

Goal Setting – doubles success rate - inspirational - learning - performance

Tailoring – to meet the needs of each person - motivational readiness to change - self efficacy {yes I can} - behavioral efficacy {performing a behavior leads to an outcome} - preferred learning style *printed material *face-to-face *telephonic counseling *web-based

“Most appropriate for individuals who are ready to take action to change behavior, transforms motivation into action.” O’Donnell, 2005 Free Powerpoint Templates

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Opportunity – having access to the environment that makes choosing a healthy behavior the easiest choice

Organizational Culture: role models, incentive systems, peer support, communication systems, etc….. Policies: smoke free, flex time, benefits, physical activity, vending, new child, etc…..

Employee Ownership: program committee, champs, ambassadors, leaders, mentors, etc…..

Ongoing Program Structure: coaching, child care, recreational, support, Weight Watchers, EAP, etc….. Physical Environments: healthy cafeterias, smoke free, ergonomic furniture, fitness center, fit stairwells, lactation rooms, massage areas, etc…..


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AMSO success matrix What is the likelihood of success? Mix and match increases likelihood of success….. Element

Low

Medium

High

Awareness

0

.5

1

Motivation

0

1

2

Skill

0

1

2

Opportunity

0

1

3

Likelihood of success: 5 or more points success is likely 4 or more points success is possible 3 or more points success is unlikely


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Creating and Sustaining Organizational Culture Cultural Symbols

Company Rituals and Ceremonies

Company Heroes

Stories

Language Organizational Policies and Decision Making

Leadership Free Powerpoint Templates

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Culture of health key word literature PubMed Search: ―workplace culture of health‖ 1,461 Total


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Saihu, et al. (2012) Pregnancy in the workplace Bugajska, et al. (2011) Role of psychosocial work factors in the development of musculoskeletal disorders in workers Staley, et al. (2011) Firefighters fitness, coronary heart disease, and sudden cardiac death Bjerkan (2011) Work and health: a comparison between Norwegian onshore and offshore employees

Franche, et al. (2011) Examining the impact of worker and workplace factors on prolonged work absences among Canadian nurses Hymel, et al. (2011) Workplace health protection and promotion: a new pathway for a healthier-and safer—workforce Chuang, (2011) Implementing complex innovations: factors influencing middle manager support Henderson, et al. (2011) A framework to develop a clinical learning culture in health facilities: ideas from the literature Merrill, et al. (2011) The impact of worksite wellness in small business

settings


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Merrill, et al. (2011) Evaluation of a best-practice worksite wellness program in small-employer setting using selected well-being indices Sirola-Karvinen, et al. (2010) Cocreating a health-promoting workplace

Della, et al. (2010) Management support of workplace HP: field test of the leading by example tool Goetzel & Pronk (2010) Worksite HP how much do we really know about what works? McDonald, et al. (2010) Workplace conversations: building and maintaining collaborative capital

Hochart, et al. (2011) Impact of a comprehensive worksite wellness program on health risk, utilization, and health care costs Kuehn (2010) Creating a healthy work environment for nursing facility Hoxsey (2010) Are happy employees healthy employees? Free Powerpoint Templates Page 35

• Culture facilitates employee responsibility and accountability • Internalizes organizational values through socialization • Support the organizational strategy • Climate is the yeast in culture change: shared vision, +outlook, community • Engagement is first step feeding from the bottom and top • Leader ownership (senior, middle, self) drives commitment • Cultural audits establish the norm gaps • Big P and little p operationalize a culture of health • AMSO – O‘Donnell program model


S U M M A R Y Page 36

How will you build and sustain a culture of health?


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