Slide 1

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 2

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 3

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 4

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 5

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 6

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 7

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 8

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 9

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 10

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 11

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 12

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 13

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 14

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 15

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 16

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 17

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 18

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 19

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 20

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 21

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 22

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 23

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 24

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 25

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 26

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 27

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 28

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 29

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 30

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 31

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 32

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 33

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 34

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 35

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 36

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 37

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 38

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 39

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 40

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 41

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 42

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 43

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 44

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 45

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 46

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?


Slide 47

Designing Effective
Wellness Programs

Bruce Coulter, CPE
Department of Labor and Industries

My Discussion




Wellness/Health Promotion Programs
Challenges in the Trucking Industry
Designing the Effective Program





Business Plan
Integration
Benefits
Culture

Workplace Health Promotion in
Washington State
Current Research Findings

Commercial Truck and Bus Safety
Health and Wellness
Programs for Commercial
Drivers

welcoa.org

Why Health Promotion?


Reduces costs






direct costs: medical insurance, health care,
workers’ compensation, accidents, absenteeism
indirect costs: employee job satisfaction and
driver retention

Increases


Morale, productivity, overall health

Wellness/Health Promotion




Employee Health and Wellness (H&W) programs
have been around for the past 30 years
Driven by:




Concern for employees
Need to control healthcare/workers’ comp costs
Desire to decrease absenteeism, lost productivity

What Are The Issues?
Health Risk Factors (characteristics associated with
increased rates of disease)

Tobacco use

Obesity

Lack of physical activity

High Blood Pressure

Poor eating habits

Use of alcohol, drugs and other chemical
substances

Various forms of psychological and job stress

CDC
435,000 deaths per year

365,000 deaths per year

416

435,000 + 365,000 = 800,000/416 = 1923

1923/365 = 5.27 per day or 2192 people

Qantas Gripe Sheets


















P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit.
S: Something tightened in cockpit.
P: Dead bugs on windshield.
S: Live bugs on back-order.

P: Autopilot in altitude-hold mode produces a 200 feet per minute descent.
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.

Qantas Gripe Sheets















P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That's what they're there for.
P: IFF inoperative.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you're right.

P: Mouse in cockpit.
S: Cat installed.

Qantas Gripe Sheets













P: Noise coming from under instrument panel. Sounds like a midget
pounding on something with a hammer.
S: Took hammer away from midget.
P: Number 3 engine missing.
S: Engine found on right wing after brief search.
P: Aircraft handles funny.
S: Aircraft warned to straighten up, fly right, and be serious.

P: Target radar hums.
S: Reprogrammed target radar with lyrics.

Wellness Program Evolution


Traditional wellness programs




Disease management




Topic of the month, non targeted, general
wellness topics (nutrition, exercise, stress)
Comprehensive campaign on a major health risk

Web based


On line participation in HRA’s, initiatives, coaching

The Hard Truth






Success is varied and often tied to the efforts of
internal champion
Challenge is that H&W is ultimately a personal
lifestyle choice
Companies can educate, encourage and even
incentivize wellness, however, ultimate decision
rests with individual

AND
Human behavior is very hard to change

Factors Affecting Trucker Health


Long workdays…sitting







Bursts of highly physical work
Poor dietary choices on the road
Sleep issues








Whole Body Vibration
Static Posture

Deprivation
Disruption
Circadian and biological rhythm interruption

Days, weeks away from home
Decentralized

Most Common H&F Risks for Drivers







Poor health habits
Driver injuries
Driver fatigue
Driver illness
Regular tobacco use
Overweight/obese






Hypertension
Poor eating habits
Lack of physical activity
Abuse of






Alcohol
prescription and nonprescription drugs
OTC cold remedies
Energy drinks

ATRI Survey of the Greatest Health
Risks Facing Drivers
Manager results:
1.
2.

3.
4.

5.

6.

Unhealthy diet
Obesity
Stress
Uncontrolled
hypertension
Sleep disorders
Drug/Alcohol use

Driver results:
1.
2.

3.
4.
5.
6.

Sleep disorders
Drug/Alcohol use
Stress
Obesity
Unhealthy diet
Uncontrolled
hypertension

Top H&W Program Activities








Exercise/physical activity
opportunities
Nutrition
training/information
Weight management
Nicotine prescriptions
Tobacco cessation
Responsible alcohol use
Cardiovascular disease
prevention









Medication management
Disease management for
issues such as diabetes and
hypertension
Flu shots
Fatigue awareness
Screening for sleep
disorders
Focus on ergonomics (cab
comfort)

Driver Survey
What can be done to get more drivers involved in H&W
program?

Offering weight room/exercise equipment for
drivers

Start a company sports team

Government mandate on H&W program
participation

Drivers – Components Offered and
Utilized the Most
Employee health risk appraisal
Nutrition & diet
advice/assistance
Weight management program
Physical fitness programs

Blood pressure screening
Regular distribution of H&W
materials

Safe driving practices and
promotion of seat belt use
Makes healthy food options
available
Encourages drivers’ family
members to participate in
H&W programs

Ensures all vehicles are
maintained in ergonomically
sound condition

United States Preventive Services Task Force
(USPSTF)






Hypertension
Lipid disorders
Obesity
Tobacco use
Breast, cervical, colorectal cancers

Advisory Council on Immunization Practices
(ACIP)


Annual Influenza Vaccination for those over 50

National Commission on
Preventive Priorities


Ranked preventive care by health impact and
cost-effectiveness






Tobacco use screening and cessation programs
42,000 deaths averted annually
Colorectal screening
14,000 deaths averted annually
Influenza vaccination
12,000 deaths averted annually

Washington Workers
Behavioral Risk Factor Surveillance System (BRFSS) data




76.3% do not eat enough fruits and vegetables
61.7% are overweight or obese
Smoking
32.4% uninsured
 14.8% insured
 3 times as common in homes with annual income
< $25,000 than households with incomes >$75,000


Resources


Guide for Community Preventive Services

Design of an Effective Program
 Business

Plan (ROI, P/L, PDCA)
 Integration
 Benefits
 Culture

Business Plan


Health Promotion is at the level of Senior
Management Team


Reports relevant measures regarding the human
resource




Budget to cover all screenings and prevention
activities




Costs and cost savings using health metrics

In current corporate environments capital is
distributed by demonstrated need and whether the
capital distributed was effectively used to help the
bottom line

Reported in Annual Report to Shareholders

Integration



New Employee Orientation
Benefits sign up





Tiered Premiums

Newsletter to Family
Annual HRA (mandatory for benefits)


Baseline data


Benefit programming (free)derived from HRA Results

Benefits




Free Primary, Secondary and Tertiary
Prevention
Free screenings








Mammography
Colonoscopy
BP
Cholesterol

Free Tobacco Cessation Programs
Support for existing conditions (HBP, diabetes)

Benefits







Percent of employee health insurance costs
should be consistent with their participation
in the program
Discounts begin with completion of an HRA
Discounts increase with participation in
relevant programming
Full discount after demonstration of reduced
risk (lowered BP, smoking cessation)

Evaluating Effectiveness
Pitfalls


Employee behavior is often measured by health risk
appraisals that have low participation rates and
overrepresentation of health-conscious workers



Participants are often compared with nonparticipants,
resulting in strong selection bias and overestimation of
intervention effect



Workplace evaluation efforts often focus either on




inputs such as program delivery that does not capture participation and
behavior change
disease outcomes, which are slow to change and may be affected by factors
outside the intervention.

Evaluating Effectiveness
Practitioners working with employers can offer more
effective workplace evaluation by:


continually tracking intervention delivery and employee
participation



measuring relevant behavior change

Incentives



Better to remove disincentives than install incentives
Barrier-reduction interventions, such as eliminating
out-of-pocket costs for tobacco use cessation, should
take priority for 2 reasons.
1. they have the broadest reach — to workers, dependents,

and retirees — and can affect all workers, even those
who do not participate in interventions
2. financial barriers are most important for low-income
workers with limited means

Benefits








Wellness Programming should be part of the
benefits package
HRA should be a requirement for employees
to receive benefits
Tobacco/alcohol cessation should be fully
funded
Screenings should be fully funded

Culture






Culture comes from management walking
their talk.
Signs don’t work, actions do.
Celebrating success, learning from failure.
If your drivers are your most valuable
resource, they need to feel that.

Other areas to address






Depression
MSDs
Sleep Disorders
Stress
Substance Abuse

How Do I Get Started?


Remember – H&W program does not need to be all
encompassing to begin to address driver health
issues



Small, incremental steps will make a difference



Make sure commitment to improving driver H&W
starts at the top and is communicated as such

How Do I Get Started?




Analyze health care and w/c claims to identify most
prevalent health risks
Develop your comprehensive plan with
representatives from labor and management and
your champion






Scope
Mission statement, measureable goals and objectives
Measurement
Realistic budget
Criteria for success (five year plan)

How Do I Get Started?


Implement an HRA which will be mandatory if
employees are to receive free health benefits


Legal needs to weigh in on HIPAA, and health insurance
security.

Starting Small


Mail monthly H&W info to drivers’ homes for driver
and family



Dedicate section of company newsletter to H&W
issues



Remember the power of peer pressure and peer
influence - drivers provide the best testimonials for
one another
Meet employees where they are.



Stages of Change


Pre-contemplation



Contemplation



Preparation



Action



Maintenance



Termination

It Didn’t Work…


Not convenient/not accessible, particularly for over-the-road
drivers




Takes too long to see the results – set goals too high
Lack of management support (management not healthy
either)



No one assigned to manage the wellness program



Failure to involve front-line management



Championing the program often doesn’t start at the top



Actions don’t support the message (e.g., serving donuts or
pizza as a snack or meal during wellness training)

It Didn’t Work…


Champion gets program going and then gets promoted or
leaves; no depth in management to carry on



Missing a clear statement of philosophy, purpose and goals



Ineffective communication



Failure to involve employee’s spouse/family - drivers need
support on home front to reinforce the message, change diet,
reduce stress, etc.



Unrealistic budget



Work culture/environment is unsupportive – vending
machines, smoking areas

It Will Work…


Do your homework to know what the H&W issues are



Set realistic goals and objectives AND performance measures



Commitment must be top-down



Smart small and dedicate resources (human and financial) to
each step



Empower drivers to be a part of the process including
determination of program components



Encourage and foster teamwork among drivers toward
common goal

My Recommendations



Find and maintain a champion
Budget for programs completely







Eliminate dis-incentives
Meet people where they are
Stay with it






If you believe in programs, fully fund them

Understand that the participation rate will be low for some time

Integrate wellness and safety and health, they belong
together anyway (Health and Productivity).
Wellness is a performance measure.

thank you for listening

Thanks for being here!

Do you have questions?

Any Questions?