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Creating a Culture of Health

William B. Baun, EPD, CWP, FAWHPWellness Coach, MD Anderson Cancer Center

President National Wellness Institute

713-745-6927; [email protected]

2012 IAWHP

Global Worksite

Health Symposium

http://www.powerpointstyles.com/



Surgeon General calls for a

healthy and fit nation

"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."

America’s Doctor


http://www.letsmove.gov/


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)



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



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.



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



Definition of culture of health―In a culture of health, employee well-

being 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



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.



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."



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.‘



Climate…the “yeast” in

cultural change

Sense of Community

Three work climate

factors when abundant

can aid in a smooth shift

to a culture that values

health & well-being…

Allen (2008)



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



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


http://2.bp.blogspot.com/-ZGvLKIXZzCs/TV6B930y31I/AAAAAAAABY8/N_5BSUdDYMo/s1600/ChangeTheCulture.jpg


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

-Build a business case for senior management

-Illustrate the value proposition to the organization

-Pitch a comprehensive program

-Build unit level management champions

Culture of Health

“Ultimately, company

needs to engage people at

all levels of the organization

to drive a culture of health

forward.”Catherine Baase, MD

Dow Chemical Health Director

Employee Benefit News (2012)



Leader ownership = driving

commitment down through other

leaders

• 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

The How:



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

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

Nayer (2009) Clinical

Therapeutics



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



Building Blocks of culture

that shape long-term behavior change

Allen (2011)

Values

Norms Organizational

Support

Peer

Support

Climate



Steps to build a culture of health

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

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 Three – Upon management approval implement the

plan

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.)



Conducting cultural auditsA cultural audit consists of three stages: assessment, analysis and

recommendation

• 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.

A

S

S

E

S

S

M

E

N

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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.”

Balanced work life

Physical activity

Stress management practice

Existing Culture

Desired Culture

Norm Gap



Gallup Healthways Well-Being IndexPublic 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.

• 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.

USA Well-

Being IndexScore Change

Well-Being

Index66.4 -0.2

Life Eval. 49.6 -0.5

Emotional

Health79.2 -0.5

Physical

Health 76.5 -0.6

Health

Behaviors63.9 +0.6

Work Environ. 47.4 -0.2

Basic Access 81.9 0.0

3/01/2012

http://www.well-beingindex.com/



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



Culture of health

Woven through our

programming in multiple

touch point strategies



Program – big “P” and little “p”

Whole

Program

Specific

Interventions



O’Donnell – AMSO

Opportunity 40%

Self confidence

Action

Skill 25%

Support

Behavioral efficacy

Self efficacy

Motivation readiness 30%

Knowledge

Awareness 5%

Modified from

O’Donnell (2005) AJHP

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

30 year quest to synthesize complex

literature into a simple , intuitive

framework of what works best…..



Awareness - Understanding the link between health

behavior & health conditions & the benefits of a healthy lifestyle

Announcements, Bulletin Boards,

Pamphlets, Payroll Inserts Billboards, DVD‘s, CD‘s,

Face-to-face Presentations

HRA‘s, Email, Self-Quizzes, Puzzles, Trigger Card,

Blogs, Interactive Voice Response, Websites,

Lunch-N-Learns, Health Screenings, Health Fairs,

Posters………………….…………………………….

Repetitive Exposure, Small Increments of Information,

Show-Discuss-Apply, Value of Information



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

Engaging individuals in the design & delivery

process, targeting & tailoring to meet an

individuals readiness to change

Used to engage

Produce health

behavior change

Shift



Improving Wellness Using

Incentives

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

Incentives should be applied in the context of communications, climate,

and culture of an organization

Terry & Anderson (2011)

Progressive-based

Incentives

• Considers starting point of

each individual

• Risk adjusted rather one-

size fits all

• Potential to engage those

with unattainable health

standards

• Participant-centered



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



Opportunity – having access to the environment that

makes choosing a healthy behavior the easiest choice

Physical Environments:

healthy cafeterias, smoke

free, ergonomic furniture,

fitness center, fit stairwells,

lactation rooms, massage

areas, 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…..

Organizational Culture: role models, incentive systems,

peer support, communication systems, etc…..



AMSO success matrixWhat 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



Creating and Sustaining Organizational

Culture

Cultural SymbolsCompany Rituals and

Ceremonies

Company Heroes

Stories

Language

LeadershipOrganizational Policies and Decision Making



Culture of health key word

literature PubMed Search:

―workplace

culture of

health‖

1,461 Total



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



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?



S

U

M

M

A

R

Y

• 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



How will you build and sustain a culture of health?


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