Assessing Workplace Health Risk: A Collaborative Approach to a Research based Workforce Health Risk Assessment Kelly Blackshaw Stacy Goulder Lynn Long

Foothills Health Calgary EMS Calgary EMS

Assessing Workplace Health Risk:

     History – Foothills Health Consultants/EMS Why conduct a health risk assessment?

Workforce Health Risk Assessments [WHRA] – – – Selecting a WHRA Factors assessed Delivery of a WHRA EMS Case study Costs, outcomes, & evaluation

Foothills Health Consultants Ltd.

  Vision – healthy people, working in health organizations, living in healthy communities Motto – “our clients don’t care how much we know until they know how much we care!”

FHC cont….

   Company – 1978 100 Calgary based company's – offices or affiliates in: – Victoria, Edmonton, Toronto, Montreal, Halifax, St. John’s, Fort McMurray, UK, USA Personal Health Programs – – affiliated with Scripps, Mayo and Wellmax  Occupational Health Services  Workplace Health

The Team

 Dr. Susan Lea CEO, Medical Director  Kelly Blackshaw, President   Dr. Peter Gant Dr. Tony Lynch – Occupational Specialist  Dr. Alison Bennett  7 kinesiologists, 2 dieticians, 2 psychologists, 1 nurse

Research

    2004 Reliability and Validity - University of Calgary 2005 It Takes 2 to Tango – Personal and Organizational Resilience as Predictors of Strain and Cardiovascular Disease in a Work Sample - Journal of Occupational Health Psychology 2005 Assessing Health Risk in the Workplace – A Multi-faceted Approach 2006 From Practice Based Evidence to Evidence Based Practice – NIOSH/APA

Three Key Business Beliefs

1.

2.

3.

Individuals can maintain Low-Risk Health Status even as they age!

An employer can Help its employees maintain Low-Risk Health Status The major economic benefit is in paying attention to the individuals with Low Risk Status as well as the Moderate and High-Risk employees because the natural flow of health care costs is to increase with ageing [cost follows risk]

Why do workplace health promotion?

 Health promotion is the science and art of helping people change their lifestyle to move toward a state of optimal health  Sound economic case for comprehensive workplace health promotion  Lifestyle change can be facilitated through a combination of efforts to: - enhance awareness, - change behaviour, and - create environments that support good health practices

EMS Corporate Alignment

Mission

Proudly serving a great city by preserving life, promoting safety, and improving health, thereby

“Caring for the Community”.

Health, Safety & Wellness Policy Supporting Organizational & Employee Wellness

Vision



The City of Calgary can ensure that all of their employees are offered a fully funded annual Wellness Assessment.



EMS in partnership with Foothills Health Consultants is supporting the Worksite Wellness Program which is directed at managing a healthy organizational culture.

Corporate GOAL/EMS Involvement

1998 - the City of Calgary approved a Corporate Wellness Strategy to help address issues impacting employee health, productivity, operational costs and increasing service demands.

2001 Health – Calgary EMS became involved with HR by offering and Wellness clinics to administer vaccinations, conduct blood pressure testing, as well as handing out nutritional and cardiovascular information.

influenza 2002 - in response to numerous requests, EMS began to test cholesterol for High Density Lipids (HDL) and Total Cholesterol.

Con’t

2003 - a nutritionist was also on hand to provide nutritional information and body fat analysis. 2004 - feedback from previous clinics showed there was interest in having glucose testing included. 2004 – EMS ran a pilot project of Wellness Assessments for 100 City of Calgary employees.

2005 – City of Calgary’s goal is to provide organizational support to help and encourage employees to seek information and make lifestyle changes to improve and maintain the state of their health overtime.

Well-being Assessment Program in partnership with Foothills Health Consultants.

5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 2001 24% Increase 13% Increase 2002

Year

2003 6.62% Increase 2004

Collaborating with EMS

  Vision – Tom Sampson Access – EMS already onsite delivering other services i.e. flu program   Trust - confidentiality Capability – have the knowledge and facilities  Partnership – Delivery model – Medical follow up

Benefits to Employees

   Improved employee access to wellness opportunities Increased awareness in personal health, wellness & worksite concerns Increased employee knowledge: – Messages are clear and concise and backed by rigorous scientific knowledge – Results are targeted to the individual delivered by a credible messenger

Benefits to Employees

       Promotes self responsibility for personal health, wellness and worksite satisfaction Personalized report with recommendations Follow-up by health professionals if high risk Intervention programs available for employees ready to change Personal stress management strategies Identification of resources for personal & business problem solutions Motivation for lifestyle change

Benefits to Employer

       Optimizes productivity Reduces long term costs related to employee health Encourages positive company culture Improves communication Promotes well-being in the workplace Provides corporate feedback relating to the overall wellness of your key resource your human resources Addresses occupational stress

Health and Work

 How does poor health affect work?

– – – Sleep deprived  Problem solving  Memory  Alertness  Concentration Poor nutritional status  Stress coping Physical Inactivity  Stress coping  Cognitive function

Work & Health

        Employment arrangements Occupational stress Fatigue, stress and health Organizational climate & culture Impact of long work hours on employee health Burnout Relationships between job characteristics, engagement and health Work environment and mental health

Soaring Realities

  Rising health care costs Competitiveness – talent pool   Ageing workforce Replacement of workers – knowledge and skilled  Retention  Labor shortage

Wake up to the cost of poor health!

   General Motors – employees with 2 to 3 lifestyle risks [smoking, overweight and high cholesterol] found health premiums increased $582 per person from 2001-2005.

North West Mutual Funds charges smokers an extra $300.00 per year for their benefits Orbitform – employees can have their health insurance cut in half if they agree to meet with a health coach twice a year on company time.

Alberta College of Family Physicians 51 st Annual Scientific Assembly February 26, 2006

• As we face the graying of the “Baby Boomers”, and the terrifying advance of our true pandemic,

obesity

(and all that follows from it), we understand that the greatest costs to the health care system are yet to come. • These costs, may, in fact, bankrupt individuals, organizations and societies (ourselves, our children, and our grandchildren included).

• Screening and providing interventions are paramount

Leading Causes of Death & EMS Related Calls

 Heart disease          Cancers Cerebrovacular diseases COPD Accidents Pneumonia and influenza Diabetes Suicide HIV infection Homicide US Data 33.2% 23.7% 6.6% 4.2% 4.1% 3.6% 2.3% 1.4% 1.4% 1.2% EMS [calls 2005] 6173 652 deaths 1567 1519

Foothills Health Consultants Workforce Health Risk Assessment

      Quality – research proven Design – length, factors included Appeal – easy to navigate methods – web, IVR, P&P Suitability – audience appropriate Cost effectiveness – outcome measures Multiplier effect – ability to influence others [i.e families and communities]

Workforce Health Risk Assessment

48 Factors

Workforce Health Risk Assessment

    Web - instant personal profile Aggregate data report for Organization High risk follow up – lifestyle risks by health professionals –kinsiologists, psychologists, dietician and nurses High risk follow up - medical risks by physician

What do employees need in order to feel healthy:

 Practice healthy behaviours  Available personal resources and supports  A healthy work environment  Job control

Physical Health

         General Health Status Body composition – BMI plus girth Smoking status Alcohol patterns Driving habits Self care practices Health screening practices Family history Environmental factors and safety

Physical Health cont…

    Biometric measures – Blood pressure – – – Height, weight, BMI, waist girth Cholesterol – total, HDL, LDL, Trigs Glucose Physical activity Nutritional Sleep

Theoretically ANY man can wear the same size pants from high school to retirement!

20’s

“Healthy”

30’s

Lifestyle changes

40’s 50 +

Early signs & symptoms of disease Chronic disease

Blood Vessel of a Healthy 20 Year Old

Rough Vessel Lining plus Blood Clot = Heart Attack

Behaviour Change

 Weight loss readiness to change  Physical activity readiness to change  Smoking cessation readiness to change

Behaviour Change

Psychologically Healthy Workplace

A psychologically healthy workplace fosters employee health and well-being while enhancing organizational performance and productivity.

American Psychological Association

Psychological Health

            Work/life balance Personal control Stress in personal/family life Stress levels at work Leisure time/time for self Emotional health Personal relationships Relationships at work Social networks Concentration Memory Rewards

Work Factors



Organizational climate

– Task completeness – – – – – – – Job control Job demands Career opportunities Participation in decision making Job definition Job security company support

Work Factors



Workplace conditions

– Physical environment – – Work hours Work load – Shiftwork – Environmental factors and safety

Work Factors



Job satisfaction

– Valued at work – – Change management Receiving adequate feedback – Over all work satisfaction – Intent to turnover – Commitment to the organization – Rewards

48 factors

Job Resilience Work/Life Demands Personal Resilience

20’s

$

Workplace Health Model 2006 Natural Flow of Health Status

Poor Lifestyle habits Signs & Symptoms Chronic Disease & Illness •

Lack of sleep

•

Poor nutrition

•

Lack of exercise

•

Poor stress coping

•

Smoking

•

Alcohol 30 – 40’s



BP



Cholesterol



Sugars



Body Weight



Stress Fatigue Sleep Apnea Depression



Concentration



Memory



Alertness

40 –

50’s

•

Heart

•

Diabetes

•

Cancers

•

Depression

•

Sleep disorders

•

Osteoporosis

•

Lung diseases 50+

$$$$

Health is a strategic issue!

 There is no “one size fits all” program

How to Improve Employee Health

        Focus on the work environment Focus on employees Provide Information and Education Establish Policies Promote Employee Participation Provide Resources & Support Be Flexible & Innovative Develop a Wellness Committee

Business Case [224 Employees]

 Development of a Collaborative Approach: – – – – 2002 – Initial Health Risk Assessment [FHC] 2003 – Second Assessment [FHC] 2005 – Partnered with EMS 2006 – EMS delivered program       Administration on-site measurements Immediate feedback for individuals at risk Prepared and delivered personal reports High risk follow-up with FHC docs Follow-up counseling session planned for low and moderate risk – Relationship with client well established for other health promotion activities

Organizational Cost Drivers

  The following account for approximately 25% of health costs – – – – Absenteeism STD/LTD WCB Turnover Presenteesim accounts for approximately 75% of the health costs [presenteeism is the loss in productivity that occurs when workers are on the job, but not performing their best.

– 7.5 to 10 times greater than absenteeism costs Harvard Business Review

Presenteeism [work slowdown]

 Dr. Wayne Burton, Sr. VP and Medical Director, Bank One reports the following factors impact presenteeism: – – – – ↑Blood pressure ↑Cholesterol ↑Sugars BMI ≥ 27 ↓concentration ↓ memory ↓ alertness - exhaustion – – Fatigue Sleep apnea - burnout - allergies – Depression - pain disorders/MSK

Challenges

   Implementation – making it work Integration – applying the knowledge looking for the causes behind the results – physical health, psychosocial health, work culture Innovation – adjusting and influencing process

What is made by man – man can change!

Costs/Outcomes/Evaluation

   Costs – Vary from $20.00 - $200.00 per participant Outcomes – – – – – Policy changes Improved health status Repeat measures Lives saved - priceless Intervention programs implemented – BP, Weight, EFAP Evaluation [VALUE] – – Participation rates Anecdotal stories

ROI

 Research on ROI in Canada is not tracked to the same degree as it is in the US. This is due to the fact that the effects and outcomes differ according to the various factors built into the measurement scales.

– – – – Absenteeism Benefit claims – drug costs Lost days due to illness Canadian health care utilization  Researchers Shepard in Canada, Goetzel in the US

Quotes from CEO’s

   Donald Rendall CEO of PepsiCo “you can’t run a company with half well people” David Honeywell CEO of Welcoa “Starting a program without determining needs is the kiss of death”.

Wellness is like herding cats – it takes time

The function of protecting and developing health must rank even above that of restoring it when it is impaired.

Thank You Kelly, Stacy & Lynn

Knowledge Transfer

 Dr. John Lavis says a message is “ A compelling idea that relates to the audience’s decision-making and suggests who should “act” and what should be different”.

Personal Well-being Determinants

    Societal level – Population health determinants Workplace health level – – – Work culture Work organization Policies Job level – Work load, work hours Individual level – Personal health practices

Increase your success potential!

     Incorporate a broad based approach Meet the needs of all employees regardless of their current health status Recognize that the needs, preferences and attitudes vary Recognize that an individual’s lifestyle is made up of an interdependent set of health habits Adapt to the special features of the work environment

Presenteeism

 Dr. Ron Goetzel – Cornell University [Journal of Occupational and Environmental Medicine, June 2004] “Employers need to weigh the costs of good medical care against the potential for on the job productivity losses.” When other costs where added to losses from presenteesism, the most expensive cost was high blood pressure, followed by heart disease, mental health problems, arthritis and allergies

What do you want to measure?

 Engagement  Burnout  Stress  Culture  Job satisfaction  Health

Health Management in the Workplace

Healthier Person Better Employee Gains for the Organization Lifestyle Choices Health & Productivity Management Programs Job Performance 1.Individual Attitudes 2. Group Attitudes 3. Energy Levels 4. Vitality 5. Empowerment 1. Health Status 2. Work Life 3. Health care costs 4. Productivity - absence - disability - WCB - Presenteeism 5. Recruitment & Retention 6. Best place To work

Wellness Program Components

– – – – – – – Annual Health Risk Assessment High Risk Intervention Medical follow-up Moderate Risk Lifestyle counseling follow-up Blood testing Health education activities On-site fitness centre Newsletter/ information

Increasing Program Participation

      Use team meeting time Personally encourage all employees [C-suite, Managers, wellness coordinator] Emphasized incentive and a “you can do it” approach in early years Promote a friendly sense of competition Later de-emphasized the incentive Program participation becomes the norm

Workplace Wellness Program

  Goal • Healthy and productive employees Scope of the Health Risk Assessment (HRA) •Collect objective data for known risk factors for heart disease and diabetes: •blood pressure •body composition (BMI, waist girth) •cholesterol •glucose (blood sugar) •Self reported personal lifestyle habits •Self reported worksite factors