creating a culture of health · creating a culture of healthcreating a culture of health “in a...

Advancing the Global Community of Worksite Health Practitioners 1

Creating a Culture of Health

William B. Baun, EPD, FAWHPUniversity of Texas MD Anderson Cancer CenterUniversity of Texas MD Anderson Cancer Center

713-745-6927; [email protected]

The Total Value of Worksite Health Promotion - 2010 Executive Summit 04-07-2010


What is a Culture of Health?WorkSet Creating a Culture of HealthCreating a Culture of Health

“In a culture of health, employee well-being and organizational success are inextricably linked. It aligns leadership, benefits, policies, i ti dincentives, programs and environmental supports to reduce barriers to active engagement and sustainabilityengagement and sustainability of healthy lifestyles across the healthcare continuum.” http://www.centervbhm.com/lb/workset.html


Advancing the Global Community of Worksite Health Practitioners

Continuum of Healthcare ChallengeContinuum of Healthcare Challenge Movement Along the Continuum

33% - 59% of Next Years Cost Group

Healthy Employees w/o Health

Employees w/ Health Risks

Employees with Acute Illness/injury

Employees with Chronic Disease

Employees on DisabilityTraumatic Injury

RisksLow riskOptimal Health

ObesityStressHigh blood pressureetc.

Doctor visitsER Visits

DiabetesHeart disease cancer

Cancer

The Total Value of Worksite Health Promotion - 2010 Executive Summit

etc


Program ModelsgProgram Model

Main Features

Primary yFocus

15% - 29% 30% - 65% 66% - 98%Usual Percent Participation


Chapman WebMD (2007)


Value Based Health Management

The planning, design, implementation, administration, and evaluation of health management practices that are grounded in

id b d id li h h l h ievidence-based guidelines across the healthcare continuum.

Initiatives primarily focused on innovative practices that demonstrate the greatest total value through value based benefitdemonstrate the greatest total value through value-based benefit design, primary prevention, risk reduction, and chronic disease management.

Center for Value Based Health Management (2008)



V l f H lth P ti / W ll P

6

Value of Health Promotion / Wellness Programs

1-2% Active Opposition Organizations should examine their

15-20% Opposition

Opposition Organizations should examine their stories and goals for a compelling wellness vision.

At J h & J h th ’

30-40%Q i S

40-50% NeutralAt Johnson & Johnson the company’s history and future are seen as about finding ways to promote health; wellness is embedded in how people

5-10% Wellness

Quiet Supportersp p

think about their employer.

Employees express a range of attitudes toward wellness

Championstoward wellness.

J. Allen (2008) Achieving a Culture of Health



A Culture Change FormatFor Creating a Health Culture

Normative SystemsNormative Systems

Fifty books and Fifty books and journal articles ……



Normative Systems

Norms

Touch PointsShared Values Priorities

SupportsWork Climate / Culture

Modified Allen (1987) Organizational Unconscious


Organizational Unconscious


What is Corporate Culture?

• Founding father of corporate culture• What a group learns throughout its history• How it relates these lessons to its internalHow it relates these lessons to its internal and external environments• Surrounds us and is pervasive and

lEdgar Schein Sloan Fellows Professor of Management Emiratis

complex• It is the personality of the organization• Culture can be seen, heard, and felt in the many ways an organization reveals itself



We See, Hear, Feel Culture in ......

• How the furniture is arranged• How the furniture is arranged

• What employees brag about to one another

Artifacts – visual organizational structures and processes

Edgar Schein (1997) Three Levels of Culture

• What employees talk about at water coolersEspoused Values – strategies, goals,

and philosophies

Edgar Schein (1997) Three Levels of Culture

• The reason employees are rewarded

and philosophies

• The type of reward employees receive

• What employees wear

Basic Underlying Assumptions –unconscious, taken for granted, and thoughts and feelings,


What employees wear


What is Corporate Climate?

11

What is Corporate Climate?

Shared Vision - Emerges when employees“Strongly linked to Shared Vision Emerges when employees have a chance to integrate their personal goals and approaches with team or organization’s goal

g ycorporate culture, but not as deep or as stable. Woven throughout the culture of an

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

throughout the culture of an organization and helps create the general feelings and atmosphere The yeast

Sense of Community – Present when

and atmosphere. The yeast in culture change!”

Judd Allen Cultural Psychologist

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



Both corporate climate andBoth corporate climate and culture have significant influence on shaping ofinfluence on shaping of health behaviors and

ti !practices!



Norms 13

“the way we do things around here”

A wellness culture features norms that make it easier for people to maintain healthy lifestyles:

• Responsibility / accountability for health• No tobacco • Regular physical activityegu a p ys ca ac y• Healthy eating• Stress resilience practices• Getting enough sleep

Maintaining positive relationships• Maintaining positive relationships



Shared Values and Priorities

1. Perceived to be consistent over time and across situations

2. Encompass both attitudes and behaviorsbehaviors

3. Provide standards for evaluating oneself, other individuals, and social entities

Core ValuesCaring – Integrity – Discovery



Touch Points M h i f bli hi d i i i

15

Mechanisms for establishing and maintaining norms ……Touch Point Questions to Consider

Modeling Do leaders and opinion makers model healthy behaviors?

Rewards and Recognition What behaviors are being rewarded or recognized?

Recruitment and Selection Does the community recognize this as a health oriented culture?

Confrontation How are unhealthy behaviors confronted?Confrontation How are unhealthy behaviors confronted?

Orientation How do new employees learn about the wellness vision?

Training Are employees taught the knowledge, skills and commitments it takes to be well?takes to be well?

Rites, Symbols, and Rituals Are there special events, daily / monthly activities reminders that wellness is important?

Communications Are people given the information and feedback needed to maintain healthy lifestyles?healthy lifestyles?

Relationship Development Are friendships and teams formed around healthy behaviors?

Resource Commitment Are employees given the time and resources to be well?



Multiple Touch

I di id l

Touch Points

Individual Employees

Targeted Groups

Di i ip

DivisionsDepartments

Climate

Culture



Supports



Peer Support

18

Peer Support Assistance from friends, family, and coworkers to achieve and sustain a healthy lifestyle

• Establish mentoring relationships• Teach goal setting using stages of change• Teach goal setting using stages of change• Locate effective role models and / or wellness buddies• Eliminate barriers to change• Find or create supportive environments• Work through relapseo t oug e apse• Celebrate success



Friendship as a Health FactorFriendship as a Health FactorSpecial Article (NEJM, 2007) The Spread of Obesity in a Large Social Network over 32 Years Nicholas A Christakis M D Ph D M P H andNetwork over 32 Years Nicholas A. Christakis, M.D., Ph.D., M.P.H., and James H. Fowler, Ph.D

• 1971 – 2003, 12,067 individuals part of Framingham Heart Study• Incidence for obesity was 57% higher if they had an obese friend• Incidence for obesity was 40% higher if adult sibling became obese (brothers 44% / sisters 67%), sibling of opposite sex not effect• Incidence for obesity 37% higher if spouse became obeseIncidence for obesity 37% higher if spouse became obese• Persons of same sex had more influence than opposite sex• No effect if immediate neighbor became obese• Closeness of friendship is relevant to spread of obesity and closer f f fffriendships had more of an effect• Spread of smoking / or cessation did not account for spread of obesity



Harness Social Networks to Spread PositiveHarness Social Networks to Spread Positive Health Behaviors

• Create grass root peer-to-peer marketing effort generating high interest• Create grass root peer-to-peer marketing effort generating high interest and participation• Having a leader / champion to form and maintain the group is important• Small group – under 10 individuals, self selected / nominated• Group decides wellness goal, time commitment (4-12 weeks)• Coach / wellness staff facilitate progress and provide content• Group meets 1 time a week with coach, but might meet multiple times a week participating in support activitiesweek participating in support activities*walks together, eating together, yoga, Tai Chi, stretching together, meditation together• Group agrees on metrics and measuring tools, coach / wellness staff f ilit tfacilitate• Coach / wellness staff evaluate and communicate results• Group decides if they want to continue



Categories of Individuals InvolvedCategories of Individuals Involved in Your Social Networks

• Central connectors – most information flows through these individuals• Boundary spanners – individuals that directly link to other groups outside their section department orother groups outside their section, department, or division• Information brokers – located between connectors and spanners and facilitate indirect connections• Peripheral people – operate on the perimeter, represent an underutilized resource• Bottleneck – might be ineffective at their job (job too big) or they use control issues to impede progressbig), or they use control issues to impede progress• Unsung heros – individuals that do the invisible work



Organizational and Management Supportpp

• Build and maintain senior management support for the program• Align your VBHM strategies with the business short and long term goals• Have a clear understanding of management’s expectations and the metricsexpectations and the metrics • Work hard at providing ownership opportunities for middle and line managers for the program• Provide special management programs that support th i l l d i f th b i ftheir personal goals and reinforce the business case for the program



Environmental Supports

Aging WellLaughter YogaArt of Calm Aging Well

Working Working Mothers Mothers RoomsRooms



Policy SupportPolicy Support• Tobacco• Paid time off to attend employee

development / wellness trainingp g• Worksite wellness committee• Program champs or ambassadors• Use of Employee Assistance Program• Use of Employee Assistance Program• Vending machine • Catering & food service

Ph i l ti it• Physical activity • Participation in community-sponsored,

company supported eventsWorking Mother / lactation room use• Working Mother / lactation room use

• Flexible work hours / arrangements• Commuting / biking

• Employee discounts, subsidies

• Childcare / eldercare

• New moms & dads


• New moms & dads


Create the “Right” Supports Reduce the barriers that impede healthy lifestyles

Journal of Extension (2009)



Putting It Together and Building a Culture of Health Step One: Assess your Organizations Readiness

1 Talking to senior management and gauge their commitment1. Talking to senior management and gauge their commitment2. Interview human capital managers to assess perceived

barriers and opportunities 3. Conduct observational “walk arounds” 4. Conduct focus groups on special issues that arise from

previous fact-finding5. Review the most recent employee satisfaction or job climate

surveyssurveys6. Conduct surveys / assessments

* cultural audit tools* satisfaction surveys* implement health risk assessments* provide biometric screenings* offer fitness assessments



Putting It Together and Building a Culture of Health Step Two: Analyze the Results

1. What does management perceive as being important in creating cultural supports?

2. What do your employees perceive as being important in ti lt l t ?creating cultural supports?

3. Are there synergies in their perceptions and attitudes?4. What cultural supports can be implemented with the least

resource commitment, but have a significant impact?esou ce co e , bu a e a s g ca pac5. Do you need to pilot a program before making broader

changes?6. Are there managers that might commit to being your program

champions?champions?



Putting It Together and Building a Culture of Health Step Three: Upon Management’s Approval

Implement Your Plan / Program Mix

Physical Activity – Nutrition / Weight Management – Parenting – Stress - Tobacco

Program Intensities

Awareness

Behavioral Change

Environmental Support



Putting It Together and Building a Culture of Health Step Four: Continue to Build, Maintain and Strengthen the Formal and Informal Leadership Networks

1. Human capital team – cross functional group of managers that ensure program goals and strategies are aligned with p g g g gthe organization’s business goals

2. Wellness committee – employee volunteers who serve as a sounding board

3 Wellness “champ” network employee volunteers from3. Wellness champ network – employee volunteers from throughout the organization that help promote and market the program

4. Wellness mentor networks – employees willing to be trained and serve as lifestyle change mentors to other employees

5. Third-party stakeholder groups – key VBHM vendors



Putting It Together and Building a Culture of Health Step Five: Continue to Evaluate Program Progress

1. Observations2. Interviews3. Focus groups4 W ld C fé4. World Cafés 5. Health Risk Assessments6. Surveys

*Report progress to key stakeholders: staff, employees, management, third-party partners

*Consider developing a health report card or health*Consider developing a health report card or health dashboard to benchmark and report your progress



Questions?The Total Value of Worksite Health Promotion - 2010 Executive Summit 04-07-2010

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