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Measuring Health And Wellness

By: Karen Seward

Employee health and wellness is becoming more evident in the workplace. However, Karen Seward, of The WarrenShepell Research Group, says without measurable results, employers are moving cautiously into offering these programs.

If employees are a company’s most valuable asset, as just about every corporate vision and values statement contends, then there is an advantage to be gained from making an investment in their health and wellness. Sound logic, yet it’s difficult to accomplish in practice. Human resources leaders seem unclear about what programs to implement, what results they can or should expect to achieve, and what measures will demonstrate the effectiveness or impact of such programs. Worse still, there is evidence that employers attempting to be proactive about employee wellness may be doing exactly the wrong things.

The first problem – as it usually is – is one of definition.

Wellness, itself, is a term that can mean many things including:

Perhaps least tangible, but most integral, is that wellness is dependent upon a healthy corporate culture, involving leadership, respect, choice, and flexibility?

Measurements Depend On Definitions

The measurements depend on the definitions. If wellness is about flu shots, then success is fewer people absent with the flu. But rarely can a wellness initiative be so directly linked to a specific, measurable, and short-term result. More often, wellness is about all of these things and the effects of any wellness program will be interactive, cumulative, and, most likely, long-term.

Not only that, but the success of a wellness initiative may be most evident by what doesn’t happen, rather than by what does. Fewer people end up absent from work, fewer people end up with heart disease, and fewer people are obese, stressed out, depressed, and unproductive.

But if success is what doesn’t happen, how is it measured? An ounce of prevention is worth a pound of cure, but is much more difficult to weigh.

Obviously, we’re faced with a complex task, one that involves a high tolerance for ambiguity and imprecision, and one that demands the acknowledgement of any number of moderating and mediating variables … things that get in the way of any cause-and-effect proof of value. But before we get to the issue of evaluation and measurement, we must address the content of the wellness programs – what problems are they to address, and how best to address them?

Political, healthcare, and business leaders have been leading the call for organizations to understand and account for the health and wellness of their own employees. There are some indications that organizations have increased their efforts to introduce health and wellness initiatives. A recent Ipsos-Reid/Warren-Shepell questionnaire showed that 19 per cent of human resources professionals surveyed at the recent HR Professionals Association of Ontario (HRPAO) conference in Toronto are planning to dedicate more of their budget next year to programs to reduce the costs associated with psycho-social problems in the workplace.

Similarly, the 2003 Buffet Taylor National Wellness Survey Report shows a rise in the number of mid- to large-size employers that have at least one wellness initiative in place, from 64 per cent in 2000 to 84 per cent in 2003. Some of the most popular include:

Evidence Of Increased Focus

While there is evidence of an increased focus on employee health and wellness in Canadian organizations, there are also indications that employers are struggling to know exactly how to translate that focus into activities that are meaningful to employees and to the organization as a whole.

In both of these surveys, there are interesting discrepancies in terms of what HR leaders perceive to be the most important or valuable wellness interventions and how these interventions should be evaluated and measured. Despite asking very specific questions, these two surveys show that while wellness initiatives are being embraced in greater numbers, a company’s ability to evaluate their impact – much less their return on investment – remains in question.

The Buffet Taylor survey revealed a significant gap between respondents’ stated objectives for implementing health and wellness initiatives and the potential or actual measurement of the achievement of these objectives. Of the 83 per cent of organizations that implemented at least one wellness initiative, the reasons for doing so include:

These latter two items, ranked third and fourth respectively, come closest to defining the value of wellness in economic terms, but the remaining reasons were decidedly vague and quite likely impossible to measure.

Of those offering a wellness initiative, only 20 per cent characterized their efforts as “comprehensive” (defined as a program that includes multiple wellness initiatives, continuous evaluation, and the calculation of return on investment [ROI]).

Furthermore, of those with comprehensive wellness programs, the overwhelming majority – 82 per cent – indicated that their goals in having such a program were to improve employee morale, with improving productivity and influencing long-term, overall health care costs trailing almost 20 points behind.

Most perplexing, more than half of those with a comprehensive wellness program admitted that they did not calculate or record the ROI, in direct contradiction to their previous statement.

The issue of value has perhaps been best explored by the seminal work being done by the Conference Board of Canada. Its 2002 study, Health Promotion Programs at Work: A Frivolous Cost or a Sound Investment? suggests that the question posed in the title – whether the investment in health promotion offers an acceptable return – is the wrong one to ask.

Instead, Kimberley Bachmann, the study’s author, says organizations should evaluate programs by how well they are aligned with organizational goals – such as human capital management, ‘employer of choice,’ or triple bottom-line reporting objectives – making wellness more about strategy than tactics. Bachmann offers compelling evidence that the debate around whether these programs have demonstrated satisfactory economic returns is over – they clearly have. She cites the examples of General Motors, DuPont, Johnson & Johnson, and Citibank (all U.S.-based); as well as Amex Canada Inc. and MDS Nordion (Ottawa). Each of these companies launched integrated, multi-program wellness promotion campaigns with clearly defined metrics for evaluating their success and each achieved quantifiable improvements in areas such as physical health and wellness (blood pressure, weight loss, and smoking cessation); absenteeism, disability, and employee turnover.

Making Headway

While it appears that HR leaders and others are making headway at introducing wellness into their organizations, the effort to measure the success of these is still at the starting block. In order to make progress in the second, critical phase of wellness programming – the evaluation of effect or impact – human resource leaders must ask themselves: “Does the organization understand the issues that impact its health care costs well enough to implement targeted wellness initiatives that achieve measurable results?”

In attempting to understand an organization’s cost drivers, we must look at the company’s unique and specific employee demographics, including socio-economic, gender, age, and job characteristics; corporate culture, structure, and leadership; its marketplace and desired market positioning; the impact and drivers of change; the organization’s philosophy, vision, and values; and many others, all of which combine to shape the employee experience. A onesize- fits-all solution is inappropriate and doomed to fail.

The previously-mentioned Ipsos-Reid/WarrenShepell survey illustrates the problem. Survey respondents were easily able to identify what they perceived to be the most costly issues that impacted their health benefit utilization: roughly the same number of respondents identified depression and stress as their “top contributors to absenteeism and/or health costs in the workplace.” Yet when asked to identify the “most serious” organizational issue with respect to absenteeism or health benefit costs, three times as many respondents indicated “stress” (31 per cent) as indicated “depression” (10 per cent).

In commenting on the survey, John Wright, senior vice-president of public affairs at Ipsos-Reid, said “HR professionals have to be careful how they are diagnosing their workforce. The results of the survey show that two very different issues, which must be treated in different ways, might be mistaken for the other.” There is no doubt that stress and depression are major problems for most organizations, but the manifestation of each problem will be slightly different for each and, therefore, the interventions will need to be different as well. What works to alleviate the auto worker’s depression will likely not have the same impact on the telemarketer’s stress, or vice versa.

Another issue is to differentiate between impact and return on investment. Too often, in the quest for return on investment, employers skip the first step: determining what impact they intend to achieve, and whether they are achieving it. Only now is the field of health and productivity management coming up with tools to measure the impact of employee health and wellness initiatives.

Further, Canada is lagging behind the U.S. in an organized approach to impact measurement. The U.S. Business Group on Health, a federally-sponsored working group that brings together corporate leaders, public and private health care representatives, insurers, and benefit consultants is working diligently to contribute to health and productivity policy development and translate that policy into workplace practices.

In Canada, although the movement is in its infancy, there are strong voices advocating for the strategic value of workplace wellness including the Conference Board of Canada, the National Quality Institute, and the Canadian Policy Research Network, all of which have mandates to disseminate knowledge and develop methods for proving that healthy workers are their companies most valuable assets and that healthy workplaces confer a competitive advantage on those organizations willing to invest in creating them.

Karen Seward is vice-president at The WarrenShepell Research Group.

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