While most healthcare systems in the U.S. offer some wellness programs to their employees, few are measuring outcomes from those programs and far fewer have engrained healthy behaviors as part of their employees' culture.
That's one of several important messages from an American Hospital Association report, "A Call To Action: Creating a Culture of Health."
"There's a need for us to call ourselves to action as healthcare organizations to lead the way for the community," says John Bluford, CEO of Truman Medical Center, which has 4,000 employees in Kansas City, MO, and an author of the report. "You literally have to walk the walk if you're going to be credible in the community."
"This is not the program of the month. It's a culture."
The idea is that in addition to saving healthcare costs for their own institutions, providers might provoke healthier behaviors in their patients by setting better examples, Bluford says. "It has to start with leadership, from the boards of trustees and on down, and the culture has to be absorbed also from the bottom up."
That means focusing attention on all healthcare system employees, including those who are high risk as well as those who frequent the gym already.
The AHA report surveyed 876 hospitals last year to determine the extent of their offerings of employee wellness programs, participation, cost and return on investment, and how the facilities measured the programs' worth.
It found that while 86% of hospitals have an employee health and wellness program, participation in those programs varies greatly, 42% of hospitals say at least half of their employees participate in one or more programs and 30% say between 10% to 30% participate in one or more programs.
Most of the hospitals that offer programs are measuring participation, but only one-third of the respondents – not nearly enough – are measuring outcomes, such as how many employees lost how many pounds, quit smoking, or reduced their need for medications through exercise and diet.
For example, only 49% of hospitals are measuring the impact of its programs on direct healthcare costs, 44% count the number of employees who lost weight, 41% the number of employees who quit smoking, 31% the rate of worker's compensation claims, 23% absenteeism and 13% rates of disability.
"You have to have a baseline, so you know, on an annual basis," Bluford says. "There's a percentage of hospitals that do this, and they will increase as this call to action takes hold in the healthcare market."
Most hospitals' programs are very new, less than three years old, the report says. And, only one-third of the hospitals surveyed that have wellness programs have made an attempt to measure their return on investment, but only 7% have successfully done so. Those that have, however, report significant return.
Both Bluford and the report say there are significant obstacles to getting hospital and healthcare system employees to accept healthy behaviors as part of the culture, even as part of a job description. But the biggest one is the failure to appreciate a return on investment and lack of funds to get such programs off the ground.
A few hospitals now make non-smoking a condition for a new hire, but it's a tougher sell – and may face legal challenges – to get hospitals to prohibit employment of people who don't exercise.
Some systems are experimenting with best practices. At Truman, for example, employees can trade up to $1,800 in paid time off hours (including sick time) for reimbursements in wellness-related expenses, such as gym membership fees, and even golf club or bicycle purchases, Bluford says.
Asked how health systems can overcome resistance that comes from ethnic or other values in which the practices reward heavier girth, or cigarette smoking. And likewise, how does a hospital system overcome the sense that among some employee groups, there's a belief that one's own health status and practices are a personal matter and not something that should be the target of an employer's pressure.
Bluford replies emphatically, "You can't convince me that people would be rather be out of shape and unproductive and sick. Sure, I agree with you that it's hard, but I don't think you can underestimate the power of leadership leading by example."
At Ochsner Health System in New Orleans, employees can get up to a $500 (single person) or $2,000 (family) discount on annual health premiums by participating in a health and wellness program, and 82% of employees participate. They have to agree to wear pedometers, and log in 7,000 steps a day.
The AHA report lists seven recommendations for systems to improve their wellness attitudes.
• Create robust health and wellness programs that serve as examples for their communities. Work with local employers.
• Start with the board of trustees and the CEO. Create indicators on computer monitor dashboards, and reinforce positive results through executive compensation.
• Provide a variety of activities, including a health risk assessment and biometric screening, and at least one intensive coaching activity based on risks and health status of employees.
• Use incentives to increase participation.
• Measure and increase participation, and then track outcomes, such as the number of employees who lowered their cholesterol.
• Realize a positive return on investment by committing to a program over several years. Use both healthcare cost savings and savings due to productivity improvement.
• Motivate employees over time and constantly reinforce participation and outcomes.