Volume 2 Health: our business
Case studies from the corporate world, putting health and wellbeing into action The dawn of a workplace health system.
1 Workplace health has come of age 4 6
Employers from around This support extends well beyond the traditional boundaries of the Community workplace to employees’ families, suppliers, customers associated Contents Introduction and prevention the world recognise the businesses, and the communities they operate in. fundamental importance There’s no denying that the advantages of workplace health are of being a partner to their manifold, both for the individuals these initiatives support, as well people in improving their as for businesses themselves. However, this relationship must be a health and wellbeing. true partnership.
There has been a fundamental shift in our thinking, recognising the importance of the workplace in supporting individuals’ health and 28 48 wellbeing: after all, that’s where we all spend a very significant part of our lives, so it makes absolute sense that the workplace provides a crucial opportunity to enable us all to live well. Changing Holistic mindsets approaches I am immensely proud that we are seeing so many amazing examples of companies in our network and Friends of the Network taking the lead on workplace health in such a variety of innovative and effective ways. It is a privilege to be able to share them with you and to be able to call upon such high quality thought and analysis in the commentaries included here.
This is the second report of the Global CMO Network and quite deliberately it moves from the challenging ideas of the first report 78 into what is working in practice – and why. I hope that the reader will find plenty of value in here and plenty of ideas for how they can partner with their own people to live longer, healthier, happier Digital lives. interventions
Dr Paul Zollinger-Read Chief Medical Officer 104 124 Bupa Mass participation and sustaining Shaping With thanks to our contributors, expert commentators, the Global engagement our world Chief Medical Officer Network and the report editors Gareth Lyon, Sirina Parr, Tarecca Musabir, Michelle Ball, Sarah Perkins, Sarah Mullin, Emilie Devienne and Julia Malanchuk.
2 3 Our intention here is both to Community and prevention continue learning from each There is a clear need to share how the challenges of what and how to other as a network as we have evaluate have been tackled and (where possible) overcome. Were the Introduction been doing so far but also to CMO Network to engage with the community and prevention agenda, share these lessons with the it will help to clear the path to a much greater understanding of what wider world for others to benefit works in promoting healthy lifestyles, over what time scale, in what from. settings and for whom – in the workplace and beyond. As always we remain committed The Global Chief Medical Officer We acknowledge and appreciate We are collectively and individually and willing to build new Changing mindsets Network is a partnership of how well positioned we are to motivated by what we have started partnerships within and outside For too long mental health difficulties have been outsourced to clinicians from around the world influence health and wellness in and that in itself is starting to send the network wherever we find Occupational Health or to an Employee Assistance Programme. Open who work in many of the world’s the workplace. We also understand a powerful message. those who are willing and share communication between employees and their managers is crucial along biggest and most ambitious that by harnessing our collective our goals. with providing people with the tools to manage their work lives and companies and are committed to power we can make a huge This report is a demonstration of emotions more effectively. However, initiatives and interventions require improving the health of the world. contribution to the global fight our journey to date. An increasing focus for us will data on the long-term impact to ensure finance holders invest in this new against NCDs. be building these partnerships approach in the future. We recognise that companies have Within are numerous examples of and our projects with others – be both a duty and an opportunity With access to the level of innovative and exciting initiatives that SMEs, governments or NGOs Holistic approaches to play a crucial role in the rapidly experience, expertise, innovation, that we are individually leading around the world. We know that We need implementation and dissemination research to identify ways changing way in which health and resources, thinking and willpower as Members and Friends of the this will be vital to our ongoing to diffuse best practices within the Total Worker Health and systems wellness is provided around the that we have within our network, Network. success. approach framework so that they become the industry norm among not world. That this duty goes above we have a significant opportunity We have grouped them into only large corporations but also small and medium-size companies. to improve the health of millions - Each CMO and contributor here is and beyond business as usual – common themes which stood out starting with our own people. a leader in that success. They and that it is ultimately an existential to us: Digital interventions matter. others in the network are leading With no end to the rise of digital health in sight, employers looking to And we are growing... 1. Community and prevention on amazing initiatives which are improve employee productivity would be well-served to think about The demands on businesses from Our numbers as a network are even now starting to reshape the how digital health can be integrated effectively into workplace health an employee health and wellbeing growing practically every month 2. Changing mindsets world. initiatives. perspective are twin; employees as more rally to our great cause – 3. Holistic approaches Similarly, as a network, our increasingly expect their employer but this in itself presents an almost projects are reaching exciting Mass participation and sustaining engagement to partner with them on their daunting responsibility – we know 4. Digital interventions stages and it is our intention to health and wellbeing, in addition to we must not fall short. Continued engagement is more likely and more effective when driven fulfilling their role as a responsible 5. Mass participation and share the first results of these in by supporting social processes, such as social conformity and social business and a net contributor to But we are heartened by the sustaining engagement our next report. comparison. progress we are making. Following the wellbeing of their communities. As such these represent just a our last report we started to 6. Shaping our world Shaping our world Ignoring this can ultimately mean small sample of what we are scope, test then deliver a number damaging reputation, diluting In each case we have asked one of already doing individually – and A critical component of shaping the future of healthcare will require of shared projects which will be talent attraction and retention, in the most exciting thought leaders the first rays of a dawning sun for a repurposing of primary care to engage and support patients in the first fruits of our labours as a addition to lowering the morale we have encountered in that space the network as a whole. understanding their preferences to avoid uninformed treatment network. and effectiveness of current to reflect on these case studies decisions at the frontlines and uninformed capacity investment and employees. The dawn of a workplace health funding decisions at the system level. We have also seen increasing and to draw out what they see as the most valuable lessons that we system is at hand. We understand the opportunities recognition in recent months by as a network and others around open to us if we forge open, other global organisations of the the world can learn. honest and powerful partnership contribution we can make and the with our people, our communities value in having us at the table. and with other decision makers to improve the health of the world.
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Walmart: Importance of associate health and wellbeing by David Hoke and Daniel Stein, MD, MBA 8
Leveraging Independence claims utilisation and trends reporting by Richard L. Snyder, MD 14
Pfizer commitment to creating a tobacco-free workforce contributed by Cary Adams and UICC. Original author Jean-Pascal Roussy 18
Financial incentives positively influence smoking cessation rates by Troyen Brennan, MD, MPH 20
Hach: Olympics and clean water by Shamiram R. Feinglass 22
Commentary: Healthy lifestyles in the workplace and beyond by Katy Cooper and Christine Hancock 24
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Our initial work focused on answering two fundamental questions: Walmart: Importance 1. Is wellbeing important to our associates and business? 2. Can Walmart improve our associates’ wellbeing?
In a 2013 pilot Walmart tested traditional approaches to wellbeing including surveying Walmart associates of associate health using a validated wellbeing assessment and biometric testing. Wellness coaches then worked with associates over a six month period. We found modest but statistically significant improvement across almost all wellbeing domains for participants. and wellbeing While improvements were evident across multiple areas of wellbeing, some areas impacted more than others. For example 13% of associates made improvements in healthy behaviours which resulted in a 7% improvement in physical health. Other categories demonstrated smaller yields: emotional security for example only showed by David Hoke and Daniel Stein, MD, MBA 4% improvement.
Significant additional insight came from secondary research into these findings. Surveyed associates revealed significant perceived barriers to work across many domains of wellbeing. See barriers chart below.
This early research was formative for Walmart. It showed how frequently associates experience psycho-social barriers affecting their work and the importance of taking a holistic approach to wellbeing. This research also Creating and implementing a rigorous Corporations spend considerable effort and highlighted the relationship associates make between their personal issues and their job performance. wellbeing programme at the world’s resources trying to nudge or incentivise their employees towards healthier lifestyles. Historically, Informed by this early research, we then performed a deep dive in the sciences of behaviour change, wellbeing, largest retailers is no cake walk. Through the success of these initiatives has been limited and successful change movements in order to determine the best path to approach these barriers in a more a commitment to the science of wellbeing and it has been difficult to document objective sustainable, scalable way. Based on this, we developed a set of guiding principles of design philosophy: outcomes. and rigorous evaluation of results, • Build a movement – don’t offer a programme Walmart’s wellbeing programmes have Walmart has taken a different tack. Based on • People follow people produced meaningful impact for our wellbeing and behavioural science research, associates and our business. Walmart embarked on a disciplined approach to • Simple improve the wellbeing of the 1.2 million associates based in the United States. • Trust + authentic + relevant = results
Using these principles, we evaluated market solutions available from the payer, disease management, and wellbeing vendor community. However, unable to find a solution that fulfilled our guiding principles, we embarked on a journey to co-create a new wellbeing solution to serve our associates. Associate wellbeing score changes in 2013 pilot Baseline Post-pilot
100 Associate self-identified barriers to work Baseline Post-intervention
0.5 80
0.4 60
0.3 40
0.2 20
0.1 0
Overall Life Emotional Physical Healthy Work Basic Healthcare Financial Community evaluation health health behaviours environ- access access adequacy quality 0 ment Physical Caregiving Personal Depression/ Financial Domains health responsibilities problems anxiety stress
8 Sources of presenteeism 9 Communities and prevention
We co-created the ZP ZP Challenge does not dictate The ZP Challenge differs from Next, we isolated the impact of ZP Challenge by creating a variable Challenge as a platform for what change the person should traditional corporate “wellness” reflecting if and how intensely the store participated in ZP Challenge. motivational engagement and make nor require that the and health programmes in We then conducted statistical analysis to determine which factors wellbeing improvement within person formally enrol or track numerous ways. Whereas typical contributed to store business performance, measured as net store the Walmart community. This their progress. Instead of using programmes tend to be more revenue. The impact was isolated by measuring the impact of ZP lagging indicators as a result, the structured, prescriptive and Challenge participation on store performance, holding other variables voluntary programme invites programme focuses on the process expensive, ZP Challenge is unique constant. This analysis showed stores that participated in the ZP associates and those they of engaging in change and building in its flexibility and seemingly lack Challenge had a statistically significant higher business performance. care about to make positive self-efficacy. This is achieved by of structure. While we cannot attribute direct causation to ZP participation, this changes in their lives. Changes focusing on change, rather than analysis found a statistically significant correlational effect between ZP The ZP Challenge was also are focused in four main areas: the outcome, which helps builds Challenge participation and store performance. The effect is independent designed to be cost-effective fitness, family, food and money. trust, confidence, and establishes a of other factors impacting store performance, and it remained consistent and scalable across our entire Changes can be anything the community of support. The intent across a variety of statistical modelling and sensitivity tests. associate base. To date, we have associate wants to pursue to is to help Walmart associates, had over 700,000 Walmart This result has been heartening for us. It affirmatively answers both our improve their lives, this was friends, and family support each associates participate in ZP questions at the outset of the work: Yes, associate wellbeing matters. captured in the ZP Challenge other in lasting improvements, Challenges. Participant enthusiasm It matters for the associate and it matters for our business. Yes, we can invitation booklet. rather than creating short-term has exceeded our original positively impact wellbeing through carefully designed and implemented winners and losers. expectations. In addition, we have programmes. In addition, we have shown that this impact is related to ZP Challenge is not delivered been pleased with the breadth significant improvements in business performance. through a mobile application or of challenge entries. In most While encouraged by our efforts, we are pursuing a variety of website; it is available through a instances, participants elect to approaches to improve the programme and help it reach more simple booklet in Walmart stores make better choices in all four associates. This year, we are introducing a digital ZP mobile application and backrooms. Since habits are categories (fitness, family, food, to broaden adoption and increase the social component. We are also social and influenced by those and money) and so are choosing adding additional infrastructure around the domains of fitness, family, we care about, ZP Challenge has to participate in four challenges at food and money. These efforts will continue to be centred around unlimited eligibility – Walmart once. creating emotional connectedness using the ZP Challenge. associates and anyone from the Furthermore, in our first three community can participate. We challenges we saw that the believe this group experience is We believe the success of this programme is a result of our average associate participant incredibly powerful since shared efforts to apply behavioural science research and create an invited four non-Walmart experience fosters greater social environment that supports a social movement within our associates to participate with connectedness, a key element of associate community. Through this approach, we have been able them. overall wellbeing. to achieve meaningful results across over 700,000 participants While we have been pleased with for a fraction of the cost of traditional programmes. It is our As part of the ZP Challenge this participation and feedback, hope that others may learn from this approach so that we can programme, participants we also wanted to better accelerate the adoption of healthy behaviours across more are invited to submit their understand what impact, if any, companies and communities broadly. stories. When associates share that ZP Challenge was having their stories, the stories are on the business. To evaluate the automatically entered into a business impact, we conducted contest that rewards them a sophisticated, statistical with recognition and monetary analysis to isolate the impact of prizes. We intentionally included ZP Challenge. We first identified this narrative component of specific associate and employment the programme: by asking characteristics that predict store people to tell us their story, and performance. We then controlled recognising them for doing so, for external factors that impact we are amplifying the peer-to- store performance, such as peer messaging component, community socioeconomics and which further reinforces social the type of retail store format. connectedness. 10 11 Communities and prevention
David Hoke – Sr Director Associate Health and Wellbeing, Walmart David has spent the last 20+ years working with a variety of organisations focusing on measurably improving the health and wellbeing of the workforce. Since joining Walmart in 2012, David has been responsible for designing and delivering offerings that improve the wellbeing of the Walmart workforce. This work has included a strong focus on applied behaviour change theory, behavioural science, persuasive technology, habit formation and behavioural insights. Prior to joining Walmart, David served with Yum! Brands where he was responsible for designing and delivering wellbeing programmes both inside and outside the US. His focus has been on engagement and the impact of wellbeing on business performance. David’s career has included work with organisations such as the University of Kentucky, SCANA, Sinai Hospital of Baltimore and DuPont.
Daniel B Stein, MD, MBA Daniel Stein is the Chief Medical Officer of Walmart Care Clinics. In this role, Daniel is working to offer affordable, convenient, high-quality clinical care for Walmart customers and associates. He co-founded and helps lead Walmart’s recently launched primary care clinic initiative, the Walmart Care Clinic, as well as other health services initiatives. Previously, Daniel worked on the health staff of the U.S. Senate Finance Committee on policy involving Medicare and Medicaid. In this capacity, Daniel worked extensively on the Medicare Modernisation Act of 2003, the Medicare prescription drug legislation, and medical malpractice reform. Daniel returned to the U.S. Senate Finance Committee in 2009 to help formulate healthcare workforce and delivery system reform proposals for Senator Baucus’ comprehensive health reform bill which formed the foundation of the Accountable Care Act. Daniel also worked previously at the Centres for Medicare and Medicaid Services (CMS) where his work focused on Medicare quality and pay-for-performance initiatives.
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How the programmes work: Diabetes Academy: The Associate Week 5: Food Cues and Habits Some examples of the targeted Wellness team partnered with Week 6: Make a Positive Action Leveraging Independence programming are as follows: Novo Nordisk to deliver to Change associates with Type 2 diabetes Asthma a four-part pilot series called Week 7: Strategy for Staying on the Diabetes Academy. This Track claims utilisation and Asthma 101: This “lunch and learn” patient-focused chronic disease with Kartik Shenoy, MD, of Temple management programme focused Week 8: How F.I.T.T. Are You? University and representatives of on lifestyle management and the American Lung Association Week 9: Ways to Stay Motivated trends reporting behaviour modification as it relates provided education on asthma to diabetes. The topics included: The goal was to reduce a and discussion of the triggers, participant’s body weight seven by Richard L. Snyder, MD symptoms, and treatment. • Physiology – the what and why percent and increase physical of Type 2 diabetes Educate Yourself on Children’s activity to 150 minutes per week. Asthma: The Associate Wellness • Meal planning – preparing for Progress was measured weekly at team partnered with St. success; learn the 80/20 rule and private weigh-ins. Christopher’s Hospital for Children about artificial sweeteners in Philadelphia and the American Heart disease The challenge • Monitoring – learn how to be the Lung Association to deliver this Heart Disease and Stroke best advocate for yourself By leveraging Independence Blue Cross (Independence) claims utilisation and trends one-hour seminar to parents. Prevention Class: Associates reporting, we are able to pinpoint the chronic conditions afflicting a significant Compelling stats were shared, such • Maintenance – set goals for joined the American Heart number of our associates and their dependents. These chronic conditions include: as: Nearly 26 million Americans long-term success and disease Association for more information have asthma, including more than management on the health issues affecting • Asthma/COPD 7 million children; asthma is the our community and learned how leading chronic disease in children; A Path to Prevention Programme: they can be proactive in fighting • Diabetes and asthma is the top reason for Participants learned how to these diseases. The one-hour class missed school days. prevent or delay Type 2 diabetes, taught participants simple lifestyle • Heart disease high cholesterol, high blood changes that can make all the Diabetes pressure, and obesity through difference in successful prevention. The presence of these chronic diseases and related poor health among the employee population can reduce Diabetes Now educational series: healthy eating and increased Get the Facts on Heart Disease productivity by contributing to increased absenteeism, excessive presenteeism, and poor performance. Through seven one-hour sessions, physical activity. Led by a trained and Stroke in Women: Associates Another reason for Independence taking an interest in the effects of chronic disease in the workplace is that participants learned basic diabetes Lifestyle Coach, the programme learned the facts and warning we view our associates’ health and wellbeing as a priority and we are invested in their adoption of a healthier self-management skills, including included a welcome session signs of heart disease and stroke lifestyle. information about medication, and eight weekly core sessions by attending a seminar presented meal planning, physical activity, designed to help individuals adopt by the American Heart Association. The strategy and blood glucose monitoring and maintain healthy habits. For example, the session taught Our strategy involves educating and motivating our associates to adapt and maintain a well-rounded healthy necessary to promote wellness and The weekly sessions included the that 90 percent of women have lifestyle and improve their overall health. In addition, the desire is to improve behaviours, create a culture of prevent complications of diabetes. following: wellness, and reduce overall healthcare costs. one or more risk factors for heart This programme is unique disease or stroke. Week 1: Welcome session Our approach delivers education-based programming around asthma, diabetes, and heart disease in tandem because it paired one-hour with a push towards regularly scheduled preventative care visits. The long-term goal is to lower condition group educational sessions with Week 2: Introduction: Fat and prevalence and reduce claims while improving the health and wellbeing of our associates and their families. individual follow-up appointments Calorie Detective with a registered dietitian. Through In 2016, Independence partnered with the American Heart Association, the American Lung Association, and these personalised sessions, Week 3: Strategies to Reduce Fat Novo Nordisk – along with our internal clinical team and in-network dietitians, to create targeted programming participants received support on and Calories in the workplace. how to manage lifestyle changes Week 4: Get Moving: Physical for living with Type 2 diabetes. Activity
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Overcoming hurdles What’s next? Consistent participation and long-term The intent is to complete the course and continue engagement are two programme hurdles. By to introduce opportunities to educate and engage including the targeted programming into the our associates to adapt and maintain a well- Independence Wellness Rewards Programme, an rounded, healthy lifestyle. increase in the participation rates of individuals – particularly those with Type 2 diabetes is evident. For 2017, work is underway to promote educational offerings that reach our associates at home. By A targeted programme addressing the issues reaching our associates at home, we will also be surrounding Type 2 diabetics, that also able to influence and educate our associates’ acknowledged provider issues (namely the limited dependents to live a healthier lifestyle. time physicians spent with patients addressing health concerns and the importance of medication Lessons learned for Independence and adherence), resulted in consistent attendance by other companies programme participants. We noticed that past strategies were not succinct and offered too many programme options. The During the programme series, a significant increase associates became too overwhelmed with choices. in participation and engagement was observed, We believe our consolidated approach, tying so we are encouraged that this will drive optimal the programming back to the strategy, enables results. associates to streamline their focus.
Richard L. Snyder, MD Rich Snyder is senior vice president and chief medical officer at Independence Blue Cross. He is the company’s chief clinical spokesperson, and has overall corporate responsibility for medical, quality, pharmacy management, and all clinical policies and programmes.
He leads Independence’s efforts to improve the quality of patient care by transforming primary care delivery to the patient-centred medical home model, which focuses on a team approach to accessible, well-coordinated primary care, and promoting the adoption of the accountable-care model among the provider community.
He is active in a variety of state and professional advisory committees and is a member of the AMA, the Pennsylvania Medical Society, the American Academy of Family Physicians, and the Pennsylvania Academy of Family Physicians.
Dr Snyder is a graduate of Franklin and Marshall College and the Medical College of Pennsylvania. He is board- certified by the American Board of Family Medicine.
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As with any policy change, there An analysis of Pfizer’s results are issues and challenges to by the World Heart Federation Pfizer commitment to be met. Pfizer has been able to (WHF) published in Occupational manage specific site issues by Health magazine concludes that increasing communications at the smoking cessation programmes creating a tobacco-free site level. should form a core element of a business’s workplace wellness Pfizer’s U.S. Healthy Pfizer policy, integrated with “broader wellness programme offers wellness programmes to address workforce resources to assist colleagues and other chronic disease risk factors, their dependents to stop smoking. such as promoting a healthy diet The programme includes a and increasing physical activity. contributed by Cary Adams and UICC. Original author Jean-Pascal Roussy website that includes the smoking cessation support programmes, In addition to the CEO Cancer Cary Adams, CEO, Union for FAQs, communicator’s toolkit Gold Standard, Pfizer has also International Cancer Control and reimbursement forms. The joined the Clinton Global Smoke- Cary Adams has a BSc Honours degree in Economics, Computing results of a cessation programme Free Challenge. This initiative and Statistics from the University involving Pfizer colleagues seeks employers who will commit of Bath, and a Masters degree Cary Adams and the team Pfizer is committed to help address As a company, Pfizer has fulfilled from four European countries to becoming one hundred percent (with Distinction) in Business at UICC have provided us the global tobacco epidemic the requirements to be in such (Spain, Germany, France, and smoke-free, totally eliminating Administration. He is a Harvard Belgium) were published in smoking and tobacco smoke at the Business School Alumni having with a case study from by supporting multi-faceted an elite group. Listed below are and comprehensive tobacco the milestones that the company Occupational Health magazine workplace. attended the School’s Executive one of their partners – General Management programme control measures to prevent the has achieved along with its in 2012. The employees who and has recently been awarded Pfizer – who they work chose to participate each development of future generations commitments to becoming a “Pfizer places the highest honorary doctorates in with closely on a number of smokers, encouraging and global tobacco free workplace: received 12 weeks of smoking value on the health and International Relations and Health. of projects. UICC support enabling smokers to quit smoking, cessation support. This varied wellness of its colleagues and • In July 2009, all Legacy Pfizer In 2009, Cary moved from the and encourage all of and helping ex-smokers remain according to local factors such their families, and protecting sites in the United States and as legislation, reimbursement management of international smoke-free. To that end, measures the health of both smokers their partners to take on Puerto Rico had implemented businesses in the banking sector to limit smoking in the workplace and work culture, as well as the fighting cancer (and other smoke-free campuses per the and non-smokers requires a to become CEO of UICC in along with programmes to support personal preferences of the Geneva. requirements of the CEO Cancer tobacco free workplace policy NCD) risk factors in their Pfizer employees in their smoking smokers themselves. However, Gold Standard such as the one we have.” – workplaces. This includes cessation efforts are implemented each of them benefited from UICC unites the cancer Rick Bruno, Sr Director community to reduce the global using a suite of toolkits in Pfizer facilities around the globe. the support of a stop-smoking • By December 2010, all Legacy cancer burden, to promote programme, run by a locally- Health and Wellness, US which were created with Wyeth sites in the United States greater equity, and to integrate In February 2009, Pfizer created based, independent organisation, Bupa surrounding cancer and Puerto Rico had complied cancer control into the world a new Global Tobacco Free and offering a choice of face- in the workplace. This case with the Tobacco Free Policy health and development agenda. Workplace Policy that not only to-face, group, telephone, or Its rapidly increasing membership and established smoke-free study also appears in this prohibits smoking in all Pfizer online counselling. This was base of over 1000 organisations in workplaces suite. UICC believe that buildings but also includes a funded by Pfizer, at no cost to more than 160 countries features the world’s major cancer societies, Pfizer are a good example ban on using tobacco products • As of January 2013, Pfizer had the participants. on Pfizer property as well as ministries of health and patient of a company that is taking twenty-three countries which had groups and includes influential company owned vehicles. The The results showed that after a leading role in this fight. complied with the Tobacco Free policy makers, researchers and implementation of this policy three months in a smoking Workplace Policy requirements experts in cancer prevention and cessation programme, quit rates enabled Pfizer to be recognised control. UICC also boasts more as a CEO Cancer Gold Standard • Pfizer’s goal is to implement the ranged from 40% in France to than 55 strategic partners. company, one of 100 companies Tobacco Free Workplace policy at 66% in Spain. Cary has also served as Chair to be acknowledged for this all locations across the globe. of the NCD Alliance, a coalition prestigious award. of around 2,000 organisations working on non-communicable diseases.
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Financial incentives positively influence smoking cessation rates by Troyen Brennan, MD, MPH
As a health company focused on helping The trial included 2,538 participants. Of those who people on their path to better health, and were assigned to the reward-based programme 90% accepted the assignment compared to 13.7% with the estimated cost of employing of those who were assigned to a deposit-based a smoker in the United States at $5,816 programme. In terms of smoking cessation rates, more compared to a non-smoker, it six-month abstinence was measured and overall it is not surprising CVS Caremark were showed that all four incentive based programmes keen to explore different options to were more effective (9.4%-16%) compared to effects of smoking; national policies, behavioural rates by using financial incentives. The cost of encourage successful quitting. However, usual care (6%). Looking deeper into the incentive programmes and pharmacological approaches these incentives to the employer, even with a $800 to understand the most effective method structures, reward-based programmes were more effective in smoking abstinence (15.7%) compared have helped reduced smoking rates in the United payment per person borne entirely by employers of incentivising smokers to quit, they to deposit-based programmes (10.2%) due to States. However, the need for new approaches is and paid only to those who quit would be offset by commissioned a randomised trial to the higher engagement of this type of incentive clear. the significant estimated additional cost (related explore the options further. structure. to absenteeism, presenteeism, smoking breaks, Employers are in a unique position to support healthcare costs and pension benefits for smokers) The study involved randomly assigning CVS The significance of social support was assessed by health and wellbeing programmes, and as shown of employing a smoker compared to employing a Caremark employees and their relatives and comparing group-oriented and individual-oriented by this study; continue to drive down smoking non-smoker. friends to one of four incentive programmes or programmes. It could be hypothesised that to usual care for smoking cessation. Two of the group-oriented programmes would be a greater incentive programmes targeted individuals, and driver of quit rates because people are strongly two targeted groups of six participants. One of motivated by social comparisons. However, the Troyen Brennan the individual-oriented programmes and one of results showed similar six-month abstinence rates Troyen Brennan, MD, MPH, is Executive Vice President and Chief Medical Officer the group-oriented programmes entailed rewards between the two. of CVS Health. In this role, Dr Brennan has responsibility for CVS Health’s of approximately $800 for smoking cessation; healthcare and wellness programmes. the others entailed refundable deposits of $150 So what does this mean for employers and Previously, he was Chief Medical Officer of Aetna Inc. Prior to that, Dr Brennan workplace health more broadly? It is widely plus $650 in reward payments for successful served as President of the Brigham and Women’s Physicians Organisation. In his understood that smoking is one of the leading participants. Usual care included informational academic work, he was Professor of Medicine at Harvard Medical School and causes of preventable illness and death worldwide. resources and free smoking cessation aids. Professor of Law and Public Health at Harvard School of Public Health. And after more than 50 years since the release of the first Surgeon General’s report on the harmful Dr Brennan received his MD and MPH degrees from Yale Medical School and J.D. degree from Yale Law School. He completed his internship and residency in internal medicine at Massachusetts General Hospital. He is a member of the Institute of Medicine of the National Academy of Sciences.
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Hach: Olympics and clean water by Shamiram R. Feinglass
In the lead up to the 2016 Summer Olympics in Rio de Janeiro there were significant concerns regarding the city’s polluted water venues. In a place where more than 11,000 of the world’s greatest athletes were converging, concerns were particularly rife for those set to swim and boat in Rio’s waterways – due to human sewage, with associated health risks from bacteria and viruses. Hach played a key role in ensuring that athletes, tourists and local residents all benefited from improved water quality during the games and since.
Hach Brazil had responsibility for of the city is not connected to a wellbeing benefits through their monitoring the water quality and formal sanitation system. Even in pride in working for a company safety in the Olympic complex, areas where wastewater systems that guaranteed water quality and 24 hours a day. Their online multi- existed, only about half of the safety for tourists and citizens of parameter monitoring system sewage is treated before entering Rio de Janeiro. One Hach associate operated right at the gates of the Rio’s waterways. said, “When you think about the major Olympic venues to ensure products you sell and how they there were safe water quality Hach is determined to help have an impact in such a serious improve these conditions. As part levels and to prevent any danger topic, it reinforces the reason Shamiram R. Feinglass, MD, MPH of a terrorist attack (including of their effort to improve quality why you wake up every morning of life in Rio, after the Games, all A native San Franciscan, Shamiram potential poisoning). Equipment and go to work.” Interestingly, R. Feinglass, MD, MPH is a graduate the equipment has since been simultaneously monitored pH, Hach associates derived further of Smith College who strives to drive reallocated throughout the city conductivity, Oxidation-Reduction wellbeing and satisfaction from talent diversity in every environment to provide continued monitoring Potential, fluorine, chlorine, being inspired by their colleagues in which she works or leads. A US across multiple neighbourhoods. It turbidity and organics in nine taking such a pride in this work. federal affairs policy professional locations throughout the city. is now operated locally by CEDAE, before she was a medical doctor, Rio’s environmental sanitation Exploring the opportunities in their Dr Feinglass earned her Medical Beyond the Olympics services company for water supply, work to bring wider and sustained Degree and Master of Public Health This dilemma for the 2016 sewage and other sustainable value to the local community from the Emory Schools of Medicine Olympics’ water venues solutions in environmental has meant that Hach and Hach and Public Health. She completed an Internal Medicine Residency at Oregon Health Sciences University, was decades in the making. sanitation. associates are able to derive a Preventive Medicine Residency at Emory School of Medicine, the Although Rio’s population ongoing pride and wellbeing In addition to the obvious health Robert Wood Johnson Clinical Scholars Programme at the University of had sky-rocketed to 12 million, benefits from leaving a legacy in benefits to the athletes and Washington, and is Board Certified in Preventive Medicine. Dr Feinglass appropriate wastewater treatment Rio, knowing that they played a officials whilst they were doing currently leads Global Medical, Government, Reimbursement, and Clinical infrastructure had not kept role in bettering the water safety in what is after all their job, Hach Affairs for Life Sciences and Diagnostics at Danaher Corporation. up. According to an article on the city for years to come. associates derived significant RioOnWatch.org, about one-third
22 23 Communities and prevention
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engaged management leading by example, full Walmart’s ZP Challenge is set out in a booklet in buy-in of employees, alignment of infrastructure Walmart stores and backrooms. It is available to Commentary: with healthy choices (such as a healthy canteen or all in the community in recognition that habits are prominent stairwells), and careful messaging and social and are influenced by people we know. In the education on healthy living (including maintaining future, the ZP Challenge will be even more widely Healthy lifestyles in the mental wellbeing – one in four people will suffer available through the use of digital technology. from mental illness at some point in their life). Independence Blue Cross has, to date, provided Consulting and tailoring programmes to the needs education (including on childhood asthma and of employees is also essential. The programme at prevention of diabetes and heart disease) to its workplace and beyond Independence Blue Cross targets its education on employees – but in the future this will be expanded healthy living to employees at particular risk – such out of the workplace and into homes, potentially as those with (or at risk of) Type 2 diabetes or reaching many more people. by Katy Cooper and Christine Hancock heart disease. Making a difference in the local community can Beyond the workplace to the community also increase engagement of employees and While it may sometimes feel like we spend our improve morale and pride in what they do and whole lives at work, what happens at home and in for example, through volunteering or through the community also affects our health. There are community-health improvements such as Hach’s People at work are generally aged 16-70 and often spend at least eight hours a day in the opportunities for workplaces to act as a wellbeing work in water sanitation in Rio de Janeiro. hub, sharing programmes, reinforcing positive workplace, five days a week, for over 40 years. During this time, health (or lack of it) plays A particular challenge, with which the Global behaviour, and extending the ‘culture of health’ to a key role in productivity – affecting absenteeism and presenteeism, and consequently CMO Network may be able to engage, is how family, friends and local communities. impacting the bottom line. But while careful management of existing ill-health is to foster a culture of health within small and important, the potential of the workplace goes far beyond this: it is during working life Several of the case studies in this chapter medium-sized enterprises (SMEs), which that the risk factors for long-term conditions accrue, and the workplace can play a pivotal demonstrate the potential for mobilising this often lack the knowledge and resources role in keeping employees well, preventing or delaying the onset of long-term diseases sphere of influence, reinforcing the healthy habits to encourage healthy lifestyles. Sharing that are being established in the workplace itself. and optimising shorter-term physical and mental wellbeing. Also, the workplace does not initiatives and knowledge with local suppliers Both the smoking-cessation programmes featured and SMEs (such as the Health and Wellbeing exist in isolation – offices, factories, call-centres and healthcare facilities are all embedded here were offered more widely: Pfizer’s programme Local Business Partnership pilot in 2011–12 in within the wider community, and can act as hubs for positive action among employees’ (offered to colleagues and their dependants) had England) can begin to bridge that gap. families, friends, suppliers and the local population. The five featured case studies address a quit rate after three months of 40% in France and several aspects of health-promoting workplaces – pointing the way to a more holistic, 66% in Spain, and CVS Caremark’s reward-based inclusive approach to wellbeing. programme (offered to relatives and friends of employees) had a success rate twice that of usual care.
Beyond sickness to prevention lifestyle risk factors, particularly CVS Caremark will not only have Chronic, non-communicable tobacco use, physical inactivity, long-term health benefits for those diseases – cardiovascular disease and what we eat and drink. they help to quit, but will also (heart attacks and stroke), cancer, lead to less sickness absence (on There is an increasing awareness chronic lung disease and Type 2 average, employees who smoke There is an increasing awareness that maintaining that maintaining good physical diabetes – are responsible for the take more days off per year than and mental health of employees majority of the disease burden non-smokers) and fewer smoking good physical and mental health of employees is is essential for the good health of and are a cause of early death, breaks. business, particularly as retirement essential for the good health of business years of disability, early retirement age rises. The benefits of health Creating a ‘culture of health’ within and sickness absence. Yet many promotion can also be shorter the workplace – in which healthy cases of these diseases could be term – the smoking-cessation behaviours are encouraged – relies prevented or delayed by tackling programmes run by Pfizer and on many factors, including fully
24 25 A word on evaluation The case studies vary in the level and type of One of the most significant challenges for any evaluation that took place, including a randomised initiative to improve the health of workforce or controlled trial at CVS Caremark and an community is evaluation. The gains from delaying assessment of what improves wellbeing at NCDs may be seen as long term, falling well Walmart that influenced the eventual design of outside the business cycle. However, there are also the ZP Challenge. shorter-term benefits of (for example) increased There is a clear need to share how the challenges physical activity and quitting smoking. There is a of what and how to evaluate have been tackled trend for increased reporting on wellbeing, but in and (where possible) overcome. Were the Global 2013 a RAND Health study found that 30–40 per CMO Network to engage with this agenda, it cent of US organisations with workplace-health will help to clear the path to a much greater initiatives did not even measure participation. understanding of what works in promoting healthy This matters: without measurement (including lifestyles, over what time scale, in what settings at baseline), the impact of any initiative cannot and for whom – in the workplace and beyond. be evaluated. This will have consequences for the sustainability of the programme within the organisation itself, and also reduce the likelihood of other organisations adopting a similar model.
Katy Cooper – Assistant Director at C3 Christine Hancock – Founder and Director Katy is an experienced researcher and writer of C3 Collaborating for Health on chronic disease prevention, having worked Christine is an experienced nurse, specialising in in this field since 2005. She is primarily cardiac nursing, but also working in midwifery, responsible for C3’s publications, and works community and mental health. She became across C3’s portfolio, with a strong focus on a health service manager and was a CEO in workplace health. Britain’s NHS for Waltham Forest, a diverse area of north-east London serving 200,000 Her previous jobs include time at Amnesty people. For 12 years she was CEO and general International UK, the International Business secretary of the Royal College of Nursing and Leaders Forum and Maplecroft, roles in which then president of the International Council of she worked on developing ways to involve Nurses where she was involved in policy-making businesses in human rights. She is also a through WHO and other UN bodies and visited trustee of the Sussex Cricket Foundation and 50 countries looking at their healthcare. In the is a keen cyclist. UK she has been a governor of De Montfort University and is a trustee of a charity for homeless people. Christine is a member of the NHS Healthy Workforce Advisory Board, overseeing efforts to create a step change in the health of the 1.2 million-strong NHS workforce.
26 27 Changing mindsets
Value based interventions by Hilary Thomas 30
PwC: Giving our people a green light to talk about mental health by Beth Taylor 34
Wellbeing in the work place by Philip Tidd and Annelise Tvergaard 36
Improving mental health: A new approach is needed for lasting benefit by Jay Brewer 40
Commentary: Changing corporate mindsets by Bill Mitchell 46
28 29 Changing mindsets
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We are currently in the process of KPMG in the UK’s Wellbeing team to Mindfulness practice sessions working with Microlink to introduce provides a range of tools including run by members, leadership Value based their services for the management counselling services to give breakfasts and discounted access of workplace adjustments. This will colleagues access to professional to the Headspace app, BeMindful help us speed up the time between support. Its focus is on making collaborated with Breathe – our interventions an employee raising a request for sure we challenge stigma, equip LGBT Network – to recognise support and the adjustment being our managers with the guidance to International Day Against implemented. It will also bring provide appropriate support and Homophobia and Transphobia by Hilary Thomas together all the adjustments we ensure people know how to seek in recognition of the greater make for individuals, helping us to help when they need it most. prevalence of poor mental health track activity and measure their in this group. impact. Another initiative we have created is BeMindful – our mental health Similar collaboration was held Employee Mental Health employee network (one of 14 with the firm’s disability network networks) – which was established in recognition of the lesser- Our new offices in Canary Wharf entire building accounting for KPMG in the UK’s approach to KPMG in the UK is two years ago after a partner recognised impact that disability were recognised by the BCO Best 69 calories. It is anticipated that improving colleague mental health committed to providing and a director spoke out to can have on a person’s emotional Corporate Workplace London and over time, staff will be able to takes the view that the whole firm a diverse and inclusive all staff about living with their and mental health. In 2015, South East Region and Winner burn more calories as they climb benefits when we feel able to talk working environment where own mental health conditions. People Leaders attended ‘Fit for of Workplace Lighting Award. the stairs as part of their fitness as openly about our mental health BeMindful provides a safe space Life’, training developed by our everyone can bring their Linking the lighting around the programme. as we do our physical health. When for colleagues to talk about any Learning and Development team, ‘whole selves’ to work. Tony perimeter areas to external lighting people bring their whole self to The app, backed by the concerns they have. The network providing a two day face-to-face Cates, UK Head of Audit levels allows the lighting to dictate work – having the right support Department of Health2 is growing rapidly with currently course covering overall wellness ambient lighting levels1. This , allows to manage short and long term and a member of the firm’s about 750 members. KPMG in the and resilience. BeMindful also ensures that minimum internal users to track calorie burn through mental health conditions – this Executive Committee, UK’s Mental Health Awareness developed mental health training lighting levels are maintained and a special mobile phone app engenders a healthy organisational explains: “We need to ensure Week in May 2016 included a firm- materials early to a specific partner the perimeter lighting switches off programmed around individual culture and a mindset that people wide campaign launching a ‘This Is group in early 2016 and we plan to that all our people are when there is sufficient daylight. height and weight. By tapping in feel increasingly safe to disclose healthy and able to reach and out on the smart signs every poor mental health. Me’ role model film about physical up-skill our HR Business Partner and mental wellbeing. In addition community with similar material their full potential. This not We have also developed Green time staff take the stairs they can Travel plans for our offices and calculate exactly how many flights in 2017. only means encouraging encourage cycling through the are needed to burn the calories physical health, but also installation of bicycle spaces from their early morning coffee helping to make sure our and suitable locker and shower latte. people’s mental health is facilities. We have a large range of strong”. healthy eating options promoted In addition, StepJockey helps throughout our portfolio of eating to gamify exercise, creating A raft of services and initiatives places in our offices. department or building challenges underpin this aim. KPMG in the UK to add additional motivation for recognises that the provision of We have invested in StepJockey, a employees to take the stairs and a healthy working environment is health app that incentivises staff exercise. Crucially it removes the a very important factor in people to take the stairs as opposed to barriers that many employees feel productivity and motivation. It the lifts thus helping to transform prevent regular exercise including forms a key focus of our capital workplace health. Through making time, work pressures or interfering project and office development this small change staff become with social lives! Linking everyday agenda. We have sought to create more energised, healthy and exercise, and a gym facility in buildings that are highly efficient active. Stairwells at KPMG in the Canary Wharf, KPMG in the UK which staff look forward to coming UK’s Canary Wharf office have are incentivising staff to take to work in and which clients enjoy been given a makeover so that their wellbeing into consideration, visiting. they are ‘rated for calorie burn’ allowing them to embed exercise with a journey up and down the into their daily life.
30 31 In addition to a private medical insurance scheme and an Employee Assistance Programme (EAP), there is a Health and Wellbeing Suite at the Canary Wharf office, managed by Nuffield Health; a Rehabilitation Service, which helps colleagues return to work; a 25% discount off the mindfulness app Headspace; and plenty of guidance, support and information on resilience and managing pressure.
In addition to the above, KPMG in the UK recognises that encouraging good physical and mental health also involves understanding the need for a good work-life balance. KPMG in the UK runs Jump Start Friday which allows employees to leave work from 3pm on a Friday during the summer months provided they have done all of their work for the week by this time, and also gives each employee an extra day of annual leave Hilary Thomas on their birthday. Hilary is KPMG in the UK’s Chief Medical Adviser and a member of the Global Centre 1 http://www.bco.org.uk/Awards/Winners/2011/Corporate- of Excellence in Healthcare Workplace2011.aspx and Life Sciences. In this role she is involved in redesigning 2 https://www.stepjockey.com/about-us care models and pathways and helping organisations, health ecosystems and life sciences companies to navigate the changing way that the public and other stakeholders interact. Downstream this has implications These interventions have succeeded for organisational strategy and business models. She led KPMG’s because they are grounded in global health proposition, Care System Redesign from 2010- our values and reflect a holistic 2014, working across regional health ecosystems to redesign understanding of employee health. inter-organisational patient pathways and shift the provision These can serve as a model for of care to more appropriate other companies in developing their settings. Prior to KPMG Hilary spent own versions of these programmes. 23 years in the NHS including as Professor of Oncology at the University of Surrey, Medical Director of the Royal Surrey County Hospital and Group Medical Director of Care UK plc. She was a member of the Healthcare for London Clinical Advisory Group from 2007-10.
32 33 Changing mindsets
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When it comes to having more our mental health strategy, to open conversations, we believe it’s confront inevitable ethical/ PwC: Giving our people important that our partners lead commercial dilemmas as they from the front. We have introduced arise and to ensure we learn from a number of senior Mental Health experience. The Panel is chaired by a green light to talk Advocates across the firm – our Executive Board member for partners who are committed to People and membership includes supporting those who may be a small number of senior business struggling by sharing their own and HC leaders plus our Chief about mental health personal experiences and pledging Medical Officer and a Consultant availability for confidential Occupational Psychiatrist. conversations around mental by Beth Taylor We are also a lead member of health challenges. These partners Beth Taylor – Mental Health the City Mental Health Alliance have benefited from training in Leader at PwC and through this forum actively listening/signposting skills with share and collaborate with Her thirty year career has seen the Samaritans and also in Mental Beth embrace a number of other leading City businesses, Health First Aid. By having our different professional challenges including our competitors. And most senior people demonstrating spanning the disparate worlds of of course membership of the As a major UK employer, we feel that ensuring our people are healthy and happy both that mental health difficulties are banking, academia, motherhood, Global CMO Network allows firms inside and outside of the workplace is both morally and commercially the right thing to do. not a barrier to career success at professional services and like ours to openly discuss ideas, It is also part of our purpose as a firm to help solve some of society’s important problems. PwC, we hope to encourage more psychotherapy; roughly in that improvements and challenges people to speak up and crucially to order. The consistent thread That’s why PwC is focusing on how we can contribute and support new ideas to the with our peers. PwC continues to seek help early. running through these worlds is conversation around mental health. learn from its networks and, by a passion for facilitating people’s As one of the UK’s largest providing an environment in which growth and development, initially employers we are able to provide ideas are brought to the table, the as a consultant and coach and Our view is that we all have mental health just as we all have physical ribbon symbolising they were our people with a range of Global CMO Network is making latterly as a psychotherapist in training. health and that experiencing periods of psychological and emotional happy to talk about mental health resources to support them when honest and open conversations distress or being diagnosed with a clinical condition are a natural part at work. The ask we made of things get tough. This includes between employers easier, Beth has worked for PwC since of being human. We encourage our people to view mental resilience as our people was simple, easy to access to free counselling through enjoyable and productive. 2003 and in January 2016 was a core business skill and we are committed to supporting them when do, easy to explain and became our 24/7 free and confidential asked to take on a new role to One of the main things PwC has they’re struggling. We also acknowledge that, as a firm, we mirror society immensely popular with 12,500 of helpline; direct access to a new develop and lead a firm-wide learnt from our Green Light to in that there’s all too often a stigma associated with mental illness which our people wearing their ribbon mental health treatment pathway approach to mental health. She is Talk campaign is how important can make it difficult to ask for help. Too many people are still suffering with pride. available through our medical also in the final stages of training it is to harness the power of our in silence. We believe that until we shift this culture, our investment in insurers and specialist support/ with the Metanoia Institute to Our staff soon took to social media people. As a large employer, our excellent resilience interventions and treatment options are unlikely to adjustments from Occupational become a UKCP accredited to share their involvement with real strength lies in our people’s psychotherapist and volunteers deliver all of the hoped for benefits to our people and to the firm. Health. But, in order to see every photographs, pledges and advice. attitudes and behaviours. By her clinical services to work with member of our team benefit, So we’re doing a number of things to get more people comfortable As a result, during Mental Health creating a visual, simple and a branch of Mind each week. they need to feel it’s OK to ask talking about mental health, both their own and other people’s. Most Awareness Week, over 3.4 million engaging campaign, we’re for help in the first place. Greater visibly, and in response to an idea from one of our younger people, we Twitter users learned about our successfully engaging our people transparency will also allow us to have developed an internal mental health campaign entitled ‘Green green ribbons and why PwC staff in a challenging issue and getting learn more about what really helps Light to Talk’. The objectives are to destigmatise mental illness by raising were wearing them. We also had them talking. This is creating a to get people feeling better, back awareness, engaging people emotionally and providing information. great feedback from our clients, genuine and passionate response, on track and fulfilling their career We connect with our people on a monthly basis, each time highlighting with some adopting the campaign echoing our message of openness aspirations. We really do need to a different mental health topic and featuring a member of staff or a in their own offices. Following and inclusivity across channels be able to listen and learn from partner talking candidly about their personal experiences. this, the green ribbon has become we could not have reached purely others if we are to change our known throughout PwC offices as through the PwC brand. culture in a meaningful way. Our most high profile event to date took place in May coinciding with a symbol of an open door and a Mental Health Awareness Week. Based on an idea from one of our Senior willingness to talk. We have recently set up a Mental Associates, we ran a simple but extremely effective mini campaign in Health Governance Panel which which we invited all of our c.20,000 staff and partners to wear a green will meet regularly to help shape 34 35 Changing mindsets
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Wellbeing in the The reality is, the majority of us are leaving the office feeling drained, and this is having a negative work place impact on our overall wellbeing, both physically and psychologically by Philip Tidd and Annelise Tvergaard
The price paid by many for giving too much of overloaded society, our typical day can no longer themselves to work is that they often don’t exercise be conveniently carved up into these thirds and There has probably never been a more important time to address wellbeing in the enough, eat properly, maintain relationships or work has never been so dislocated from time and develop themselves in other ways that contribute place. workplace. With the ever increasing rise of NCD’s to pandemic proportions, the sedentary to long-term happiness. Neglecting activities that The revolution in mobile and ubiquitous lifestyle of many office workers around the world is a contributing factor. Yet the maintain happiness and not keeping on top of technologies has been both a blessing and a curse, workplace can be seen as a ‘macrocosm of society’ and therefore both positively, ordinary daily tasks can increase levels of stress, leading many employees to no longer leave their and negatively, affects the health outcomes of office workers in very direct ways. anxiety, depression and associated physiological work at work and therefore the number of hours conditions, such as high blood pressure. spent in the office are not always the same as the With workplace stress accounting for 43 percent of number of hours spent working. 60 percent of As a large international Every three to four years, we When the results came in, we lost work days in 2014/2015, some employers are respondents to our UK WPS respond to emails architecture, planning and then distribute the WPI℠ Survey discovered that just 33 percent now beginning to realise that happy and healthy outside of working hours and more than half consulting firm, the environments nationally via a third party to of respondents felt energised at employees are also more productive employees – complete work at home that they didn’t have time that we design directly impact help us understand not only the end of a typical working day. not to mention more innovative! to do during the (eight hour) ‘working day,’ which millions of people’s work and lives how our clients’ workplaces are Perhaps you’re surprised that the begs the question, what is the optimal working on a daily basis. In the field of performing but how the workplace number is even that high. Is the eight-hour day, in the office, at the desk, day, nowadays? Many find that working away workplace design, we consult with is performing on a national and still relevant? from the office, either from home, or elsewhere Why is it important? and research the requirements of global level and we publish this Our UK Workplace Survey respondents spend provides an effective space for working alone. end-user occupiers of office space research as the Workplace Survey Our job is just one element of our an average of 39.6 hours a week at work, which This is a damning indictment on the inability to globally and across all industry (WPS). lives, yet we spend approximately is in line with the typical eight-hour work day focus in many office environments, along with the types. This gives us great insights a third of our typical working life introduced during the Industrial Revolution at the obligation for us to be ‘seen to be there’ for at This year we launched our first into the effectiveness of the at work and on a typical day, most suggestion of factory reformers such as Robert least eight hours a day, is contributing towards truly global survey – the 2016 working environment and through people are giving much more of Owen, who recommended that we spend a third the erosion of our work-life balance. WPS, taken by 11,200 people our research projects, affords their energy to the working day. of our time at work, a third at leisure and a third in the USA, UK, Asia and Latin us the ability to reflect upon the Add to this, commuting time (in sleeping. Before then, little regard was shown for Whilst the open-plan office was designed to America regions. Our focus was environmental factors that allow the UK more than 3 million people the wellbeing of workers. get people out of their silos and isolated private on ‘bridging the innovation gap’ people to thrive in the workplace. spend more than two hours a day offices, it still has many virtues and can be very but the issues we uncovered could commuting to/from work) and Post industrial revolution cities were built on effective when designed well. But for many of the We have a long tradition be a proxy for broader wellbeing the energy we have left at the end Synchrony and Colocation – to get workers to all UK’s estimated 8.2 million people working in open- of researching workplace issues. of the working day is the energy come to work at the same time and same places plan environments today, it is a real challenge to effectiveness both through hands- supposed to be reserved for our and this pattern of behaviour is deeply ingrained concentrate. Amongst the many questions on project-based knowledge family, friends and hobbies; so our in the national psyche. Nearly 200 years later, we included in the survey was a gleaned from our Workplace relationships, physical health and are still seeking balance in our lives and trying to seemingly innocent question Performance Index® (WPI) psychological health suffer if we get the best out of our employees; but in today’s asking respondents to what extent Survey – which has been taken don’t have enough. world of a hyper-connected and information they agreed with the following by over 213,000 people in over statement: “At the end of a typical 23 countries in nine languages. day in the office, I feel energised.”
36 37 Changing mindsets
What’s behind it? With the UK currently seeing almost 10 million working days lost due to work related stress, depression and According to the UK Health and Safety Executive (HSE) almost half of workplace stress, depression and anxiety each year, firms need to encourage employee empowerment and strive to meet new workplace anxiety can be attributed to workload, tight deadlines, too much work, pressure or responsibility. Additionally, goals. Indeed, additional research we are currently doing with the Royal College of Art, Helen Hamlyn Centre long working hours, too few breaks and long commutes are an obvious drain on our energy, but when we for Design into psychological wellbeing in the workplace indicates that giving employees trust, autonomy analysed the survey data, we found that those who felt the most energised were also the same individuals who and choice significantly contributes to their psychological wellbeing – and the power of this should not be reported a greater sense of meaning and purpose in the work they do. Just as innovation occurs at all levels of underestimated. an organisation, so too does making a difference, only not everyone realises it. This is largely an engagement All things considered, even if we’ve come to accept that working and commuting saps our energy, there is still and management issue, but what’s even more interesting to us as designers, strategists and consultants is how plenty we can do to help mitigate the impact of fatigue, stress, anxiety and depression by designing spaces workplace can address the following four questions: that help everyone to understand the difference they make each day and support them in their work.
Just imagine, if you had an office that helped your staff feel as though they’ve made a difference, would you 1. Do people understand and 3. Do people feel respected and feel energised at the end of the working day? That is a goal worth pursuing. approve of their organisation’s appreciated for their work? mission and values? The quality of the design, look and feel of More than a slogan in an email signature, an employee space within the workplace and the organisation’s mission and values can be expressed provision of amenities can go a long way in making Philip Tidd – Principal/Head of Consulting EMEA, Gensler through the design, look and feel of the whole people feel valued by their employer. At a bare Philip Tidd is one of the global leaders of Gensler’s consulting practice and workplace. When the values of an organisation minimum, people should have the furniture and has spent the last 20 years working across Europe at the sharp end of where influence and are visible in the choice of colours, equipment necessary for them to work effectively business and buildings/spaces meet. He regularly works across the city and office scale and is a passionate believer in harnessing the power of creative materials, finishes and quality of a workplace (or and in comfort. In addition, nearby amenities insights to solve clients’ complex problems. any other place) it creates a consistent message that support better work-life balance, show for employees and visitors alike. Do you want to consideration for the employee. And the positive create a space that speaks of permanence and impact of good, quality coffee should not be stability or of creativity and adaptability? Should underestimated! it be home-from-home or another experience entirely? 4. Do they feel part of a community? 2. Do people understand how Respondents reported spending an average Annelise Tvergaard their own work contributes to that of only 5 percent of their time socialising at Annelise believes in the ability of architecture to improve people’s quality of mission? work, and perhaps felt embarrassed to admit to life - she enables this to happen through her consulting work. more, but it is still recognised as one of the four Especially at lower levels of an organisation, At university, Annelise studied History of Art, with a focus on medieval art essential office work modes (focus, collaborate, and architecture in Europe and the Middle East. Her particular interest is how the survey revealed an alienation from the learn, socialise). Often the first work mode to be architecture is experienced and how the physical environment in influences organisation’s overall mission. This can be sacrificed on a busy day; we know that at-work the behaviour of people. After researching for three years at another addressed through a greater awareness of what relationships are a major driver of job satisfaction international design firm, Annelise brings her knowledge of the history of art others in the organisation are working on and, and levels of innovation. Having more frequent and architecture, academic discourse and visual analysis to Gensler, coupled therefore, how all of their contributions come interactions increases awareness within teams with first-hand experience of cutting edge architectural projects. together. Consider implementing dedicated space and across teams; therefore, it also enhances on a main circulation route or communal area to Aside from researching current and future trends in the workplace, Annelise is involved with change management our understanding of how we contribute to the the display of people’s work and achievements. and building activity analysis. She takes an active role in a range of employee engagement activities, organisational mission. Spaces that increase “War Rooms,” or similar collaboration spaces communications, data analysis and the presentation of data collected. both deliberate and accidental interactions, where work can be pinned up or written on the including shared kitchen or café areas, are walls, are also very effective if they are visible to becoming more prominent features of progressive others. workplaces because of this. Designated areas for personalisation by teams and utilising hallways and stairways all help to create a sense of community.
38 39 Changing mindsets
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To help this client we focused on the group This preventative solution integrated physical of colleagues who it was suspected were and emotional wellbeing under the guidance Improving mental health: experiencing stress, job dissatisfaction and poor of an experienced Health and Wellbeing engagement but were either unwilling to approach Physiologist who also had additional training traditional support routes or had not identified in emotional health and coaching. Choosing that they required help. Deliberately we changed A new approach is a Health and Wellbeing Physiologist to run the concept away from ‘come to us when you this course was also deliberate as evidence are stressed’ to ‘what can we do to help you suggests that optimum mental wellbeing is perform at your best?’ Based on the theories of needed for lasting benefit Diener and Seligman the solution was built on the inextricably linked to other health elements principle of helping people to be at their best. This such as nutrition, sleep, activity, lifestyle encompassed helping people to develop their self- behaviours (smoking, alcohol intake etc) and by Jay Brewer awareness of emotional states and how their work current health. and personal behaviours related to these. This followed the NICE step care guidance The solution was articulated as building strengths for mental wellbeing which indicates that rather than fixing weaknesses and was made expertise increases with severity but optimum open access, which reduced barriers to entry wellbeing is created by a ‘whole person One of the benefits of The evolution from managing amount of the workforce was such as informing line management and requiring approach’ and for this a highly trained general working for a company poor mental health to developing moving towards this high stress coordination of attendance for entire teams. clinician was required. A key part of this Furthermore, although some separate courses that provides wellbeing optimum emotional wellbeing state and that the support routes relationship was bringing out and endorsing embodies the principles of the would just be endlessly filled. This were run specifically for senior leaders the courses solutions to a wide the individuals’ values, goals as well as mental wellbeing continuum which highlighted a systemic issue that were of mixed seniority as no sensitive information concerns for health and wellbeing. customer base is seeing highlights that a person can have would have a degree of success was shared within sessions. how different companies mental ill health but also good using traditional routes but This truly helped to make our approach and individuals approach mental wellbeing. This does not wouldn’t address root cause. focused on the individual and how they mean that someone suffering from the same challenge. wanted to ‘be’ in the context of their life, an anxiety disorder, depression A root cause analysis of what Without a doubt the work and relationships. or post-traumatic stress disorder affects mental health in a business overwhelmingly common should not receive the correct can be divided simplistically challenge being addressed treatment but it highlights that into two sections; what can the is mental health in the even with these conditions, a business change and what can the workplace. Mental health person can experience high levels individual change? Both of these solutions have merits but there is provision is currently in a of mental wellbeing. much evidence including the most state of development with Working with one of our key recent by the Chartered Institute of the focus developing to clients we adopted an innovative Personnel and Development in the encompass prevention of approach to addressing the mental UK that a focus on how a business ill health and cultivation health challenge. The client in works and the way it is led is of optimal emotional question was experiencing high hugely impactful on wellbeing. wellbeing by linking levels of ‘crisis moments’ where Changing leadership, businesses a hard working environment process and policy takes a positivity, engagement, was pushing many colleagues concerted effort and deliberate mindfulness, and trust to to breaking point and seeking change management. With our productivity, presenteeism support from traditional support client we didn’t have the ability and overall success. routes such as Employee to change the way the business Assistance Programmes and worked, which is very common, so Occupational Health. There was needed to focus on solely on the also a ‘feeling’ that a substantial colleagues individually.
40 41 Changing mindsets
The solution focused on a 12-week programme that utilised Mindfulness training, guided meditation, a conflict Results of pre- and post-psychometric workshop, time management training, health assessments and personal training. Initial group introductions Wellbeing Profile Questionnaire. to the programme were followed by 1:1 reviews repeated at convenient intervals throughout. The 12-week programme was also underpinned with biofeedback training using Heart Rate Variability to help people learn Emotional and physical states. the links between their bodies’ physiology, their behaviour, emotions and thinking.
Using a Wellbeing Profile Questionnaire, feedback indicated a notable and positive impact on reported Anxiety wellbeing and resilience related to programme activities. This was more marked among those showing higher I feel anxious 31% 7% engagement and adherence to specified activities, leading to a 16% increase in reported emotional wellbeing and resilience. I feel worried 38% 14%
I feel panicky all of a sudden 17% 0%
I have felt as if something awful was going to happen 17% 0% Percentage change in each area of resilience for those with high adherence above and beyond those with low adherence I feel uneasy 24% 7%
Anger 30 I feel irritated 33% 14%
I feel angry 12% 7% 20 I feel annoyed 21% 0%
I feel frustrated 38% 36% 10 I feel uneasy 24% 7%
0 Positive attitude
-10 I can enjoy the TV or a good book 60% 50% I can see the funny side of things 79% 93%
-20 Appreciative 76% 93%
Grateful 71% 64%
-30 Thankful 76% 71%
Tiredness Anxiety Anger Relaxed Positive Engagement Mental Self Control Self attitude clarity management esteem
42 43 Self esteem Self-management
I have felt less useful than usual 7% 7% I have been feeling reasonably happy 74% 86%
I have been less confident than usual 14% 14% I felt more unhappy than usual 17% 0%
I have felt more worthless than normal 14% 0% I have felt less able to enjoy daily activities 19% 7%
I have felt less able to overcome my difficulties 17% 7%
I have felt less able to face my problems 17% 0% Control
I like who I am 62% 79% Very disorganised 21% 7%
I am very self critical 69% 36% Very much in control 50% 79% Jay Brewer I have lost interest in my appearance 7% 0% I feel good about myself 57% 64% Working with over 60% of the FTSE 250 companies Jay has Able to influence what happens 57% 64% rapidly understood best practice Employee engagement for employee wellbeing and specialises in creating wellbeing Tiredness Cheerful 79% 86% solutions, which range from small tactical projects to the I feel satisfied 55% 71% Sleeping is worse than normal 24% 7% development of overarching I feel on top form 38% 64% I feel slowed down 24% 14% strategies. Regardless of the size and reach of wellbeing solutions My sleep is inadequate 43% 21% I feel very discouraged 19% 0% Jay ensures these follow a joined up biopsychosocial model I experience aches and pains 21% 36% I feel fulfilled 48% 71% of care, adopt an evidence based approach and produce Motivated 74% 86% I feel tired 50% 14% meaningful return on investment. I feel contented 55% 64% I feel fatigued 38% 14% Jay leads Nuffield Health’s Enthusiastic 74% 86% I feel exhausted 26% 14% wellbeing research, steering the Research Committee partnership I feel good about myself 57% 64% with Manchester Metropolitan Mental clarity and decisiveness University and working closely with University College My concentration is as good as ever 52% 86% Relaxed London, Sheffield Hallam and Loughborough. This research I feel tense 31% 0% I am less decisive than usual 12% 0% responsibility is complimented with a clear focus on innovation, I am very perceptive 81% 86% I can see the funny side of things 79% 93% recently developing emotional I feel it is very easy to prioritise 62% 93% I feel restless 36% 14% wellbeing services with the Director of Emotional Wellbeing I feel calm 52% 86% That it is difficult to concentrate 24% 0% and driving ‘leading measures’ of stress with digital solutions. I am mentally very sharp and quick thinking 69% 64% I feel peaceful 40% 57%
Confused about things 10% 0% I feel fatigued 38% 14%
I feel good about myself 57% 64% I feel exhausted 26% 14%
I feel good about myself 57% 64%
44 45 Changing mindsets
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The third case study from Nuffield does provide data on the effects of their initiative with a client company taking participants through Commentary: a 12 week programme covering physical wellbeing advice on lifestyle behaviours and a combination of mindfulness, guided meditation training, a conflict workshop and time management training. They report a 16% increase in emotional wellbeing and resilience on a Wellbeing Changing corporate Profile questionnaire with reductions in tiredness, anger and anxiety. Unfortunately they do not report how many people took part in the study which would allow the measurement to have some meaning. mindsets Ideally a repeat measure at a later date to assess the durability of the effects would add to the effectiveness of the intervention and, of course giving the questionnaire to another group who did not attend the course by Bill Mitchell on two separate dates would give the intervention greater credibility. Bill Mitchell The three case studies reviewed here share an acceptance of the reality Bill is a clinical psychologist who that many people in the working population will have a diagnosis of graduated from the University some psychological disorder. Being able to talk about that condition of Aberdeen. He works with and how its severity might be affected by work pressures and changes contemporary cognitively based with some colleagues who are genuinely supportive can prevent psychological approaches to It is heartening that mental Stigma about mental ill health remains a problem, many people feel that psychological ill health from getting worse and could also stop people treat anxiety states, depression, health difficulties are now if they were to be open about anxiety, depression or other psychological relapsing. stress reactions and chronic being treated more openly illnesses it would be career limiting. This belief prevents many people fatigue states. He has a from having a conversation that could be helpful; the opportunity to Giving people tools to manage their work lives more effectively and particular interest in treating and proactively than has gain support from colleagues could be enough to prevent someone manage emotions like anxiety, low mood and frustration could also work related psychological been the case in the past. gradually going down a pathway that could lead from feeling stressed reverse the gradual progression from day to day stress to ill health. difficulties recognising and overwhelmed by some difficulty to a serious illness like depression. that many people work in Considering the incidents of Gensler neatly summarise the challenges facing organisations; circumstances that can easily psychological ill health (one in four PwC introduced an innovative scheme which was suggested by an posing four key questions for employees to consider: 1. the employee lead to the loss of any balance to people suffer from psychological associate to encourage more open conversations by inviting employees understanding of the organisations mission and values, 2. how the life which increases the potential ill health at some point in their to wear a green ribbon indicating they were happy to talk about mental employees work fits with that mission, 3. if they feel respected and for them becoming exhausted lives) the serious impact it can health at work. This resulted in 12,500 people out of a work population 4. if the employee feels part of a workplace community; these areas are or ill. have on people’s careers, family of 20,000 wearing a ribbon. PwC have also introduced Mental Health known to contribute to higher levels of motivation, engagement and He also works as a consultant life and physical health, as well Advocates across the firm, partners who are committed to supporting productivity. Employees are more likely to respond positively to these to a number of companies and as the costs to organisations of others who may be struggling by sharing their own personal experiences. questions if they have been given tools to manage their work lives more sickness absence and replacing effectively, enabling employees to manage emotions like anxiety, low professional service firms; he leads workshops on such areas employees who have left because This is a recent initiative, no information is provided about how many mood and frustration could also reverse the gradual progression from as Managing Yourself, Resilience, of psychological ill health, the employees have made use of this offer of greater support but hopefully day to day stress to ill health. Managing Personal Change, increased interest in trying to do PwC will collect some data on its impact on some measures of mental All of this requires more open communication between employees and Effective Leadership, Leading something about psychological wellbeing and sickness absence. their managers and a better appreciation by managers that high pressure through Turbulence and Building health is well over due. KPMG in the UK have also picked up the challenge of taking steps to environments, major changes and periods of disruption can increase Resilience Skills for Managers. For too long mental health encourage mental and physical wellbeing at work. They have introduced the probability of employees developing a mental health condition. That He lectures on the Kings College difficulties have been outsourced a raft of services including a health App to encourage staff to use stairs then calls for helpful practical conversations to support people through London MSc programme on Mental Health Studies and he is to Occupational Health or to an rather than lifts and measuring calories expended. Be Mindful provides a the difficult work experiences rather than encouraging them to call the a visiting lecturer at the London Employee Assistance Programme safe space for colleagues to talk about any concerns they have, initiated EAP helpline. Business School. rather than being seen as after a partner and director spoke openly about their own experiences of something where everyone in an living with mental health difficulties. Organisations should also share with one another initiatives they organisation should be taking are taking in this area. But for interventions to have credibility KPMG, like many organisations also took advantage of Mental Health responsibility. they have to go beyond well-meaning enthusiasm to collecting Awareness Week to introduce employees to Mindfulness sessions and data on the effects of what they are doing and looking at the information about mental wellbeing. The real challenge here of course is sustaining these ideas and practices beyond the awareness week into the longer term impact ideally with some control measures to long term and ideally collecting some information on the impact of the demonstrate that any changes were the result of what they techniques that were advocated. instigated rather than due to chance. In this way companies are more likely to be able to persuade the finance holders to invest 46 money on these initiatives. 47 Holistic approaches
Healthy workplace by Dr T Rajgopal 50
GSK: Partnership for Prevention by Dr Murray Stewart 54
DaVita: Village Vitality wellness programme by Mahesh Krishnan 58
Be Well strategy and programme by Dominic Johnson 60
Be Well at Regions Hospital in Saint Paul, Minnesota, USA by Pronk, Hermann, Gallagher, Egan, Allen and Remark 66
Commentary: Innovating and scaling up total worker health by Terry T-K Huang 74
48 49 Holistic approaches
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The Unilever model of holistic wellbeing The flagship programme under the employee wellbeing initiative is the Lamplighter programme. The Healthy workplace Lamplighter programme has been in vogue in Unilever for more than a decade.
The Lamplighter programme is integrated in two important avenues, within the business spanning across by Dr T Rajgopal various functions and the other dealing with solutions and prevention strategies for the individual. The components of the Lamplighter programme are depicted below:
Unilever wellbeing framework
Physical Mental Unilever has a long and The USLP helps us to drive a brand and business-led initiative to established history of improve the health and wellbeing of our employees. Indeed, we Looking after our health, fitness, diet, sleep and energy Managing our mental choices and reactions to distractions prioritise our employees’ wellbeing, just as our founder Lord Lever levels so we approach challenges with zeal. and competing pressures. supporting employee did over a century ago. health and wellbeing • Nutrition • Recovery • Exercise • Focus • Empowerment and agility and our commitment Our global medical and occupational health strategy revolves • Energy management • Mindfulness is documented on our around the twin pillars of Health Promotion and Health Protection. Purposeful Emotional company corporate Health Promotion aims to promote, maintain and enhance the health website as part of our of Unilever’s people to maximise their fitness to work safely and Identifying what really matters to us and connecting to that Finding ways to feel positive and confidently face the Unilever Sustainable effectively, while Health Protection aims to protect Unilever’s people as much as possible in all we do. challenges life throws at us. from work related hazards to their health. Living Plan (USLP). • Personal purpose • Connection to USLP • Positive mindset • Self esteem • Inclusion Both Health Promotion and Health Protection are integrated in the Employee Health and WellBeing Programme. Lamplighter provides a standardised toolkit for countries to adhere to with the additional benefit of allowing “Under the Unilever Sustainable Living Plan we want to local and cultural needs to be addressed. Standardised health metrics data is measured to assess where improve the health and wellbeing of a billion people around health risks may occur with employees. This includes lifestyle factors (smoking, alcohol consumption, fruit the world. A key part of that is the wellbeing of our own and vegetable intake, exercise levels, perceived stress levels) and physiological/biochemical measurements people, not only their physical health, but just as importantly (glucose, cholesterol, blood pressure, BMI). their mental health, particularly at times of change and uncertainty. By listening and responding to their emotional needs we give people a much better chance of fulfilling their Health risk true potential, which is good for them and good for the assessment company.” - Paul Polman, Unilever CEO
Exercise
Nutrition Health Engagement Performance
Mental resilience
Scorecard
50 51 Holistic approaches
An example of the impact from the Lamplighter programme in Singapore in reducing health risks is depicted in The employee wellbeing programme is aligned to Unilever’s the figure below: Sustainable Living Plan (USLP), hence linked to business needs. This ensures success in the long run. Key factors boosting sustainability of the programme include: Lamplighter parameters Singapore 2009-2015 1. Our health and wellbeing programmes are embedded in the 4.0 business and are integrated vertically and horizontally across geographies within HR, Safety and Supply Chain 3.5 3.0 2. Our health promotion and health protection programmes form one of the pillars of “Manufacturing Excellence” 2.5 2.0 3. The global wellbeing programme is being reviewed and overseen by a global steering committee consisting of three Unilever Leadership Dr Rajgopal – Vice 1.5 Executives including the company’s Chief HR Officer thereby President, Global Medical 1.0 ensuring support and funding for the programme and Occupational Health, Unilever 5 4. Having a solid framework, consistent messaging and new and He is responsible for providing innovative campaigns to keep employees engaged has enabled 0 strategy and leadership in High blood Tobacco Physical Overweight Diabetes High Poor diet High alcohol High stress this programme to run for over 10 years and has also allowed it to comprehensive medical and pressure use inactivity cholesterol use evolve throughout that time occupational health services covering more than 165,000 Empowering employees to take control of their own wellbeing has employees worldwide. 2009 2010 2011 2012 2013 2014 2015 shown great results. This is in part supported by the bespoke way that employees are treated. Whilst the programme has a framework, there He represents Unilever in the isn’t a “one size fits all” mentality. Global Business Coalition, the Global Diabetes Forum, has been Employees are offered personalised support and goal setting based a Leadership Board member of The Lamplighter programme has reached around 168,000 employees out of 173,000 employees on what they feel is important to their health rather than an instructive the Workplace Wellness Alliance worldwide. approach telling employees what they should be focusing on. of the World Economic Forum and is on the steering committee We also measure the impact of our health promotion and health protection programmes. The Unilever six-year of the Institute of Health and value addition is depicted in the following figure: Productivity Management.
He holds postgraduate Unilever six-year aggregate ROI qualifications in Preventive Medicine, Public Health, 4.0 Occupational Medicine Empowering employees to take and in Health and Hospital Administration and is a Fellow 3.0 control of their own wellbeing of the Faculty of Occupational 2.33 Medicine, Royal College of has shown great results Physicians, and the Faculty of 2.0 Occupational Medicine, Royal 1.26 1.07 College of Physicians, Ireland. 1.0 0.84 0.23 He has served as Chairman of Return-on-Investment : 1 Return-on-Investment Medichem, Board member of the 0 ICOH and is an Editorial Board member of the IJOMEH. Healthcare Absenteeism Presenteeism Total productivity Healthcare and only only only (Abs + Pres) productivity He has been honoured by the AIHA with their Distinguished Service Award.
52 53 Holistic approaches
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We designed the programme To make this work you need a The data from employee surveys based on proof of concept pilots local country project team with reports 80% satisfaction with the GSK: Partnership that were successfully completed a clear leader and support from programme and GSK is gathering in Ecuador, Ghana, Nigeria and the business. The team includes numerous employee testimonials, Romania in 2012. These engaged representatives from Benefits, which confirms P4P is a huge for Prevention with approximately 5,800 staff Environmental Health Services, success. and dependants from across GSK Human Resources, Medical and By following this process in business units. Many preventative where appropriate legal and taxes. developing such a programme, by Dr Murray Stewart services were not included in There is also a vital role for the employers around the world can existing medical or private plans in communications team. Starting significantly improve employee these countries. in regions where publicly funded health and engagement on a preventive healthcare services number of key priorities in a Success with the pilots confirmed may be unavailable or limited, way which is genuinely globally that phasing services in by the programme is currently geography was the most efficient scalable. As a company, we recognised that the global rise in chronic non- rolling out to all GSK employees GSK has a mission to help and effective way to expand the there was inequality of healthcare communicable diseases such as and their families and will be people do more, feel better programme globally and to make provision across the countries we diabetes, cardiovascular disease complete by 2018. The first places and live longer. Although this programme a reality we have operate in. Some employees were and obesity. We’ve specifically to receive the programme were this primarily relates to the implemented this locally, following unable to afford medicines and chosen the services on offer the Middle East, Turkey and Latin diagnosis, design, implementation people we are developing others had limited access to basic because they demonstrate high America. Africa, Pakistan, India, and embed and grow. The medicines for, it is important healthcare services. We therefore value in preventing ill health Sri Lanka, Bangladesh, Russia diagnosis phase in each country that we reflect our mission set up a programme called including a range of adult and child and Commonwealth Independent reviews the current availability of Partnership for Prevention (P4P), vaccines for preventable illnesses States were in the second phase internally and ensure services through the existing GSK which tackles affordability and such as hepatitis and tuberculosis, and the programme will soon our employees and their health provision or government accessibility barriers head on to prenatal healthcare for women, HIV roll out to the Asia Pacific region families have access to a health programmes and identifies help our employees do more, feel and cancer screenings and tobacco and Japan. The final phase of the gaps to be covered by P4P. The comprehensive health and better, and live longer. cessation treatment. This approach implementation covers, Europe, design phase involves selecting wellbeing programme. is also consistent with the World North America, and the UK. We suitable third party administrators P4P is a partnership between GSK Health Organisation standards to understand that GSK is the first and negotiating services fees senior management including prevent and detect diseases and multi-national employer to commit for delivery of those gaps in support from Human Resources, we believe will have the greatest and implement a comprehensive service in that country. The key Benefits, Environmental Health impact on GSK employees and preventive healthcare programme is implementation which is done Services, Medical and the GSK their families. to nearly 100,000 employees in employees and their benefits- by active engagement between 150 countries. eligible dependents. The aim is We are doing this to foster a the local project team and the to provide access for up to 40 healthy performing workforce local employees and their families. To date GSK has launched the preventative healthcare services and we know that investment in Finally, the embed and grow phase programme in 65 countries, at little or no cost to all employees preventable health services will further raises awareness of P4P touching the lives of over 80,000 across the globe. help reduce work related illness and works to cement a culture of people, with nearly 30,000 and absence from work. This will preventive healthcare across the services being utilised to date. Preventive healthcare measures also result in a highly motivated company. On average, 22 new preventive are critical at any stage of life, and resilient team. services have been added per helping to prevent illness or detect country, with adult vaccines, adult diseases earlier. They are also an preventive exams and diabetes increasingly important healthcare screening commonly being the intervention for GSK employees gaps in healthcare provision which across all geographies, given needed to be filled.
54 55 Holistic approaches
“My little boy had some medical problems. We arrived at the Clinic and were told that the services we needed were included in Partnership for Prevention programme. Since then we have had to go for two more examinations and each time our level of satisfaction with the medical care was high.”
“Vaccination day was the first day I started using my P4P card. It encouraged me to use it and showed me how smooth the process is. Thank you GSK and P4P for allowing us to care more about our health.”
“P4P programme makes me feel like GSK is not working only Dr Murray Stewart on my development and my career and empowering me as Murray Stewart is Chief Medical an employee but also is caring about my health, my welfare, Officer for pharmaceuticals at and the health of my family, which is very important.” (Medical GSK where he is responsible for representative, Lebanon) the efficacy and safety of GSK pharmaceuticals globally.
“I believe this is a great value for employees and as a proof I Murray joined GSK in 2000 as immediately took appointments and got the vaccines… One of the Associate Director for Clinical doctors in the hospital where we got the vaccines was impressed Research and Development in the UK and since then has held senior by what GSK is doing...” (Director, GNE) positions in the Cardiovascular and Metabolic therapy area.
“I have been in this company for almost 25 years and this is the Before joining the pharmaceutical first time that I see that GSK as a whole really is trying to help industry, Murray worked as a employees to live the mission... P4P sends a really strong message diabetes consultant and senior to employees and their families about doing more, feeling better lecturer and was Consultant and living longer.” (IT Director, Chile) Physician/Honorary Senior Lecturer and Head of Clinical Services at the Diabetes Centre, Newcastle upon Tyne in the “P4P is a very important message, not just for every employee, but UK. His research was in lipid also for the worldwide community of GSK. I am sure that many of metabolism in Type 2 diabetes the services that P4P provides around the world represent the first he did his medical training at opportunity for many colleagues to take advantage of preventive Southampton Medical School health services. I feel proud to be a part of this company.” in the UK and is a Fellow of the (HR, Argentina) Royal College of Physicians.
56 57 Holistic approaches
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Other key elements of the programme and results Whilst the Vitality Points incentive include: programme has historically been the anchor DaVita: Village Vitality of DaVita’s overall wellness programming; • Chronic disease management and coaching; they are now expanding the focus to a providing behavioural and lifestyle-change more holistic approach to wellbeing by support as well as onsite healthy cooking classes incorporating four important elements and wellness fairs. Since May 2015 more than wellness programme of total wellbeing: physical, financial, 22,000 coaching sessions have been provided by emotional and social. This is referred to as DaVita’s wellness partners by Mahesh Krishnan “Village Vitality: Be Well. Physical. Financial. • Wellness Champions who promote Village Emotional. Social.” DaVita are continuing Vitality programmes and encourage participation to work to ensure supportive and valuable in local activities. The community of champion resources are available and that each of volunteers has grown from 400 in 2010 to 1,500 these four areas are covered. teammates
• Profiling successful achievements by teammates “Using incentives to encourage personal accountability, drive behaviour change and has enabled more than 200 teammates to win improve health outcomes.” the ‘We Are Well’ Award for submitting their stories about getting healthier – with some very DaVita’s Village Vitality wellness programme has become synonymous with wellness across the company since inspiring feedback from the winners: its inception in 2007. The mission is to build a culture of wellbeing by providing programmes for teammates (employees) and families that encourage personal accountability. Through dedicated leaders, meaningful ° “I have now lost 40 lbs and have a goal of incentive and solid communications, Village Vitality has: losing 50 lbs. I am off all BP medications and all my lab results are in normal range” • Measurably improved the health of teammates; and ° “16 months after my physician provided me • Reduced healthcare costs year on year with my lab results, I have lost 115 pounds, reduced my BMI from 40.0 to 23, lost 10 To achieve these results, financial incentives have been at the core of the programme. By starting the inches in my waist and have dropped seven Mahesh Kirshnan teammate, and/or their spouse or domestic partners’ journey with a free biometric screening and based on trouser sizes” Mahesh Krishnan MD MPH MBA FASN is their results they can earn points that translate into healthcare premium savings. the Group Vice President of Research and ° “In September 2011 I had an abnormal Development as well as the International Chief Incentives have been so successful that each year more than 72% (23,000) of DaVita’s teammates participate mammogram and had bilateral mastectomy Medical Officer for DaVita Healthcare Partners. and since 2013 more than 53% (6,000) spouses/domestic partners have participated as well. This large data that saved my life” set enables effective analysis of the health of DaVita’s population and reveals a five year improvement from Dr Krishnan has extensive experience in • Creating a strong culture of wellness is 2010 to 2015 of four key biometric measures. By learning their numbers through the biometric screening, healthcare. Currently serving as Group Vice embedded in every facet of the employee teammates have taken accountability and action to improve their health. The results speak for themselves. President of Research and Development and experience; from new hire orientation to a strong as International Chief Medical Officer, focus on executive leader example setting with Dr Krishnan has previously served as the the CEO and COO participating in a number DaVita U.S. teammates in healthy range for key health measures Executive Director of Medical Policy, Nephrology, of challenges, fund-raising activities and and as Therapeutic Area Head for Global Health Baseline 2015* Percentage Pt. U.S. community volunteer work Economics, and as the Global Development 2010 Improvement Benchmark** Leader for Epogen® at Amgen Inc. • Company-wide challenges and competitions: With wearable devices becoming increasingly During his tenure at Amgen, he played an Glucose 77% 82% 5 points 75% popular, DaVita held several challenges in important role on the 2007 FDA Cardio 2015 and 2016 to track activity, weight loss Renal Drug Advisory Panel for Erythropoietic Cholesterol 83% 88% 5 points 79% Stimulating Agents, served as the primary and leader-led role modelling by the CEO. The contact for the Dialysis Outcomes Practice data collected from wearables determines BMI 29% 30% 1 points 26% Patterns Study, and led many important research the proposition for future challenges and projects focused on observational research and Blood Pressure 32% 42% 10 points 34% programmes; ensuring they are customised dialysis care. He was founder and managing and targeted to empower teammates to make partner of the Clinical Consulting and Research * OHD biometric screening book of business data across the United States (230k lives). healthy changes for themselves and their Centre in Fairfax, Virginia, and prior to that, ** US Benchmark data is based on hundreds of thousands of objectively measured, biometric data points at employers across families. Wearables are also being used as prize practiced in Northern Virginia for nearly five the nation. incentives to participate in feedback surveys, years. classes and other wellbeing activities with great success. 58 59 Holistic approaches
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Be Well strategy and programme by Dominic Johnson
Barclays’ wellbeing What is wellbeing and why is it At a time when lifestyle related programme, Be Well, aims important to Barclays? chronic health conditions are to enhance our performance Wellbeing has a number of growing rapidly around the world and with healthcare systems and reputation as a great elements, but at its simplest, is about being healthy and happy. overstretched, supporting better place to work, while health for our people will enhance exemplifying the Barclays’ It is not just about physical our reputation as a responsible Barclays wellbeing culture Values and making a fitness or being active – it’s also employer, while making Barclays a A culture which supports wellbeing will enable colleagues to live Barclays’ Values and be their best at work, positive impact on the lives about positive mindset and more attractive place to join and resilience, strong social and family with the energy and focus to deliver the excellence and service our customers and clients expect. of all those who work for us. build a career. relationships, working well and Finally, we know that organisations We understand that poor health financial stability. These multiple which demonstrate real and sincere Respect Integrity Service Excellence Stewardship and general wellbeing directly dimensions are reflected in the five We respect and We act fairly, We put our clients We use our energy, We are passionate pillars of our wellbeing strategy. support for colleague wellbeing affect colleagues’ energy levels, value those we ethically and and customers at skills and resources about leaving have higher levels of engagement, effectiveness, resilience and work with, and the openly in all we do. the centre of what to deliver the best, things better than Barclays rightly does a lot to sustainable high performance and ultimately, quality of life. By contribution that we do. sustainable results. when we found support colleagues when they’re resilience through periods of major they make. them. actively supporting colleagues to unwell. This support, along with change of the kind Barclays is be healthy and happy, by helping health related absence and most embarked on. them to understand their health importantly, lost performance, is a risks and how to make sustainable, big cost for us. Through focusing Respect positive changes, we will deliver on the health and wellbeing of better outcomes for colleagues, Personal support for colleagues to promote their wellbeing, performance and quality of life. colleagues, and with greater for Barclays and for society. insight over time, this will improve Stewardship our ability to perform as an Protect and enhance our reputation as a responsible employer. organisation while reducing the costs to Barclays of chronic ill Create a legacy of sustainably improved health and wellbeing for colleagues, while reducing the impact on health and absence. stretched country healthcare systems.
Excellence Actively contribute performance, development and engagement of all colleagues.
Create the environment to attract and retain the best people.
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Our Programme Barclays’ Be Well programme is supported by a What will we deliver? The programme has five pillars: global portal which has been rolled out to United Our focus on the health and wellbeing of our Kingdom, USA, Asia Pacific, Middle East and India. colleagues, will deliver:
Think Well Set out below are some examples of the “Global • Culture change which embeds wellbeing in Our mindset and psychological wellbeing play a big role in our overall health and happiness, impacting how we feel, how Assets” and initiatives which demonstrate the scale our leadership/ management programmes and we think and how we act. of our strategy and programme: performance process
It’s important that we feel good about ourselves and the world around us. Psychological wellbeing is not only closely • Global Speaker Series – Recognised experts • Insight led interventions which deliver a return linked with health and resilience but can also help you achieve your personal and professional goals. talking on health, nutrition, resilience etc – live on Barclays investment and tangible benefit to webcast recorded for playback on Be Well Portal colleagues Be Active • Fitbit® Promotion and Challenge – Discounted • An inclusive approach which offers value for all Our physical health is key to our overall health and energy levels. We all know how important it is to keep physically and subsidised devices with international step colleagues, not just the highly health conscious active, eat well and look after our general health, but it’s not always easy. challenge to promote activity and awareness Busy professional, home and social lives often leave us with little time for physical activity. However, finding time for a bit • Personal health insights and support, enabling more exercise in our day is a great investment, as it helps improve our concentration and focus, as well as protecting us • Health Risk Assessment tool currently in place. colleagues to understand their health risks and against long term health conditions such as heart disease and diabetes. A full Global Health Risk Assessment to be make sustainable improvements available to for all colleagues in 2017. This will Being healthy and active will help us with our recovery and performance. allow us to achieve a greater level of analysis to • Innovative programmes, communications and allow us to further capture key health risks to assets, using the latest technology to support Social provide individual and group insight engagement insight, learning and behaviour Our connections and relationships with those around us are vital to our overall wellbeing. In particular, the quality of your change key relationships and the time to invest in them can have a major impact on our wellbeing and enjoyment of life. • Global Be Well Portal developed and in place with v2.0 being implemented in 2017 Since the Be Well programme started Barclays has It is important to find the time to spend with our family and friends and learn more about how we can build stronger to allow progression of the portal to the next seen an improvement in its sustained employee connections with our colleagues and our community. Barclays’ provides internal support which can help, such as the level in providing consistent and effective engagement scores. Evidence of employee Working Parents and Families Network or Dynamic Working. communication, engagement and education engagement and support is also visible through the globally high levels of activity on the internal collaboration Financial ”My Site” and the popularity of Be Well articles on • Colleague Health Screening and Proactive Financial wellbeing is an important component of our personal resilience. Life may leave us feeling stretched and out of Barclays Now intranet – activity only beaten by Health Intervention – Health screens are control of our personal circumstances, with our financial situation having a significant impact on how we feel. messages from the CEO or Chairman. conducted globally however we have We understand that money worries can weigh heavily on people’s minds, whereas good financial planning can create a commenced a risk based intervention and real sense of security and optimism about the future. coaching programme (Initially across 55,000 UK colleagues in 2016 with planned implementation We all need expert advice now and again. Whatever our situation, Barclays can support us in managing our financial of model globally using the Global HRA). 10,000 health. Discrete tools are available to manage financial wellbeing and regain control. These include access to webinars “Know Your Numbers” Health Screens for UK in on budgeting and saving, as well as access to relevant colleague financial guidance and benefits such as pension schemes, saving plans and Employee Assistance Programmes. 2016
• Performanc e management – Incorporating line Workplace manager self-appraisal and support for team Our physical environment, the culture we work in and our team, play a significant role in both our wellbeing and wellbeing performance. Barclays aims to be a great place to work and is actively creating a culture where wellbeing is valued and • Leadership and learning – Focusing on optimum supported. performance/wellbeing through integration There’s a wide range of support available to help colleagues with their health and wellbeing at work. This includes in Leadership and Management programmes, workplace assessments and adjustments, support on becoming a parent, occupational health if we have health resilience through change programme and line problems, Dynamic Working for managing our time, gym and changing facilities and healthy eating options in staff management development to focus on looking restaurants and cafeterias. after “team and self”
Line Managers play a critical role in supporting colleagues and promoting the importance of wellbeing in the workplace.
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Conclusion Barclays has always cared about colleagues’ health and wellbeing. Through the Be Well strategy and programme, we’re bringing together all the best practices and resources available to make a much bigger difference.
Whilst we still have some way to go before we can ensure consistency of delivery and measurement globally, to have achieved business support to create a programme infrastructure which allows us to progress with the programme we have and on this scale is a phenomenal achievement.
Overall Barclays would recommend that other Dominic Johnson companies looking to create a similar model, Dominic is responsible for should consider the following: global employment policy, ER governance including • Be clear on the business case and ensure the restructuring, wellbeing, industrial focus remains strategic relations expertise and third party service management (ER Direct, • Target both business and employee engagement occupational health).
• Aim for measurable results - what is poor focus Dominic joined Barclays in 2006 on wellbeing costing now, in lost performance, to lead Group ER and has had current and future ill health costs, private various roles since but always medical, lower engagement etc; how will with ER as a part, including the investment in a wellbeing programme interim HRD for Western Europe measurably improve outcomes? and Head of Organisation Effectiveness for Global Retail • Connect at every level with leadership coming Banking. right from the top He previously worked for • Make sure that the programme is embedded into GlaxoSmithKline as Director of the culture of the business ER, Policy and Diversity and as Head of Employee Relations • Focus on the connection between sustainable for the Confederation of British engagement and wellbeing Industry.
64 65 Holistic approaches
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Be well at Regions Hospital in Saint Paul, Minnesota, USA by Pronk, Hermann, Gallagher, Egan, Allen and Remark
The HealthPartners mission is to improve Regions Hospital, one of the largest HealthPartners health and wellbeing in partnership with business units with its team of 5,100 dedicated professionals, is a level one trauma centre with our members, patients, and community. one of the Twin Cities’ busiest Emergency The HealthPartners Be Well employee Departments. The stressors related to hospital health and wellbeing programme is a care are ever-present and the jobs are physically, comprehensive initiative designed to emotionally, and mentally challenging. In order address multiple levels of wellbeing. to deliver great care, service, and experience for Figure 1. The HealthPartners Be Well model The Be Well framework is depicted patients and families, the Regions leadership team knew they had to make the health and wellbeing of in Figure 1 and shows that meaning employees as much a priority as the care provided and purpose, a dimension written in a to patients – because “you cannot give to others manner that reflects the interests of what you do not have yourself.” HealthPartners employees and their families, represents an axle around which The Regions health and wellbeing journey started in earnest when leadership used data to identify six dimensions of wellbeing – namely: relationships between healthcare costs and gaps physical, community, emotional and in employee health. This commentary presents mental, social and relationship, financial the Regions experience between 2009 and 2016 and career-turn. and highlights the key drivers and the population health impact over that period.
Regions Hospital in Saint Paul, Minnesota, USA
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Drivers of success Onsite health and wellbeing resources uncontrolled stress, self-perceived poor general To circumvent challenges for employees to health status, chronic disease(s), and low life The learnings generated by the implementation of the Be Well programme over the past seven access healthcare and wellbeing resources, many satisfaction. The risk factors are scored ‘zero’ or years highlight the importance of three particular elements: programmes and services were brought to the ‘one’ based on absence or presence of the risk hospital. This saves employees from having to take factor. Respectively, the HR10 is the sum between 1. Leadership awareness and commitment to making health and wellbeing a priority and personal time off. In 2012, Regions built an onsite zero and 10 for each individual employee. leading a culture of change Employee Health and Wellbeing Clinic through The HR10 metric has undergone thorough testing HealthPartners. A nurse practitioner provides 2. Redesigning employee health benefits around individual needs and incentivising healthy so that it can predict financial impact based on easy access to diagnose simple health needs or behaviours healthcare claims expenditures and productivity supports employees with more complex concerns. changes. Productivity loss is measured with the The clinic helped lower employee emergency 3. Providing access to great health and wellbeing resources at work. Work Productivity and Activity Index (WPAI), a room visits by 5% and saved more than 5,000 well-validated survey integrated into the health production hours. assessment survey, and assessed at the same time as the HR10. Statistical modelling shows that Leadership Redesigning benefits In addition, onsite mental and emotional health resources are provided as well. In 2013 the the weighted average annual cost per risk factor HealthPartners has identified nine principles The human resources team worked closely with programme added a wellbeing coach with decrease is equal to $428 per member per year in of best practice programme design that start colleagues from the HealthPartners health plan training in emotional resilience and the Centre medical and pharmacy claims. Furthermore, the with leadership. Once data provided insights to refine the health plan benefits so as to give the for Employee Resilience was opened in 2013. weighted average annual productivity increase into the needs and care seeking behaviours of Regions staff more power over their healthcare Employees are free to hit the “pause” button when per risk factor decrease is 1.7%, a change indicator employees, the Regions leadership team took budgets. Two consumer-directed healthcare plan necessary and re-energise through meditation, that may be monetised based on average yearly time to solicit input from employees and sought options were added that increased enrolment into mindful relaxation, massage therapy or just a salaries. to understand what would engage colleagues to the health saving account option by 40% in two simple old-fashioned break. These onsite resources improve their own health and wellbeing. Leaders years. In addition, employees and dependents who The HR10 metric is adjusted for natural decline including “Be Well Moments” support lots of throughout the organisation became wellbeing use tobacco were offered a benefit differential in a population’s health as people age. Natural culture work and all this laid the groundwork for champions, planting the seeds for better health. incentive and tobacco-free efforts were supported decline estimates were modelled based on the opening of the new onsite Fitness Centre in The implementation of daily huddles allowed with a Regions Hospital campus-wide tobacco-free actual experience captured in the HealthPartners 2015. key messages related to health and wellbeing campaign. databases for a working population not exposed to to be delivered to the work teams. Wellness a well-designed comprehensive workplace health These efforts resulted in more than 60% of Measuring impact moments during meetings and healthier food and wellbeing programme. In addition, employees smokers indicating they engaged with the Often, especially in the area of health outcomes, options in vending machines and the cafeteria are tracked at the individual level over time, where campaign and 50% of dependents participating quantifying the impact of prevention suffers from were implemented as well. At the same time, the earliest HR10 becomes their own baseline in the programme as well. Access to health plan the “prevention paradox”. This is where the impact executive leaders including the CEO, modelled for evaluation. That baseline year is run through advisors, wellbeing coaches, retirement planning is difficult to measure as the events being counted healthy behaviours, provide permission for others the natural HR10 change simulation so that an and financial advisors has been made easier by do not occur and it is not clear whether this is to engage, and talk about aspects of wellbeing expected HR10 is calculated for each individual and bringing such resources on-site during open due to the programme or some other reason. In that reinforce a healthy work-life balance, such as each subsequent year. Then, each year after the enrolment and annual health fairs. the case of Regions Hospital, measurement and unplugging from e-mails and encouraging full use baseline, HR10 is considered a participation marker evaluation of the Be Well programme impact has of vacation time. for that year and the difference between expected occurred at multiple levels, including at the level and observed HR10 is measured at the individual of the population. A unique population health level. For each year since 2009, Regions employees metric was used, the Health Risk 10 (HR10) metric, participated in an employee survey that measured that was based on previously validated summary the HR10. Annual participation rates in the survey health metrics derived from health assessment were between 75% and 95% for the years 2009 survey data. The HR10 includes 10 risk factors through 2016. Based on this HR10 methodology, including: low physical activity, low fruits and Regions Hospital has been able to estimate the vegetables intake, tobacco use, alcohol intake, impact of its Be Well programme for health and obesity, unhealthy sleep patterns, too much wellbeing and financial outcomes.
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Health, wellbeing and financial impact Financial modelling for medical and pharmacy claims and productivity is shown in Figure 2 alongside the Since 2009, the HR10 population health metric indicates a steady, consistent decline in the average number changes in HR10. It should be noted that the graphic shows cross-sectional, annual HR10 scores and financial of risk factors observed. Between 2009 and 2016, the average HR10 scores declined from 2.32 to 2.05, or 0.28 savings that cumulatively reflect savings over the seven-year period. Hence, cumulative medical and units. Furthermore, as indicated in Figure 1, a comparison of observed HR10 versus the natural decline model pharmacy savings amount to $9.3 million and cumulative health related productivity-related savings amount shows the impact of the Be Well programme during these seven years. to $19.2 million or $28.5 million over the course of seven years.
Risk 10 impact: 2009 to 2016 vs. natural decline model Be Well programme impact: 2009 to 2016
3.70 2.50 $2,000 $1,800 3.22 3.17 3.20 $1,205 3.20 3.07 $1,600 $1,078 2.96 $1,036 $1,400 2.77 $1,200 2.70 2.52 $816 2.00 $1,000 2.32 $722 $630 $800 2.20 2.24 $457 $600 2.15 2.15 2.11 $579 2.03 2.08 2.05 $500 $517 $400 $413 1.70 $292 $341 $200 Baseline $223 2009 2010 2011 2012 2013 2014 2015 2016 1.50 $0 and productivity) Annual financial impact (claims
2009 2010 2011 2012 2013 2014 2015 2016 Figure 1. Regions Hospital – cross-sectional Health Risk 10 changes between 2009 and 2016
Figure 2. Be Well programme impact for Regions Hospital
Specific examples of changes in the risk factors for These positive changes are noted despite a the Regions Hospital population include reductions concomitant increase in obesity of 3.1%, the in the proportion of employees with low physical proportion of employees with chronic conditions activity of 1.4%, low fruits and vegetables intake of 10% (from 26.1% in 2009 to 36.1% in 2016), and of 18.3%, a change in tobacco user prevalence of an increase in stress risk of 1.1%. In general, these 5.7% (from 8% in 2009 down to 2.3% in 2016), and changes indicate an improvement in population a reduced proportion of employees reporting poor health status over seven years and support the self-perceived general health status of 1.5%. plausibility of financial savings.
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Conclusions Over the course of seven years, Regions Hospital has been successful at improving the health and wellbeing of its employee population. Compared to an expected increase of 0.9 risks due to the natural decline associated with aging in the absence of access to a comprehensive health and wellbeing programme, the population of approximately 5,100 employees reduced their risks by 0.28. This difference was associated with an estimated $28.5 million savings in medical and pharmacy claims costs and reduced productivity loss.
It is not by chance that Regions Hospital is one of the 150 great places to work in the USA, according to Becker’s Hospital Review. The Regions Hospital experience was clearly driven by leadership towards building a human-centred culture of health and wellbeing. The big idea was to start small, listen with intent for expressed needs of people, engage employees from the beginning, and making them the power behind a healthy, productive, and high-performing workplace.
Authors Nico Pronk – Vice President and Chief Science Officer at HealthPartners
Denise Hermann – Health and Wellbeing Manager for Regions Hospital
Jason Gallagher – Vice President for Health Informatics at HealthPartners
Kim Egan – Executive Director for Human Resources at Regions Hospital
Calvin Allen – Senior Vice President for Human Resources at HealthPartners
Megan Remark – Chief Executive Officer at Regions Hospital
72 73 Holistic approaches Friend of the Network
Furthermore, in several of the case studies, it is clear that leadership is a key factor to programme Commentary: success. This can likely happen when employee Companies often have wellness becomes a core business value subscribed to by company boards and shareholders. Leaders a larger voice than Innovating and scaling in companies can set the tone for a culture of individual community wellness in organisations and model wellness behaviours, from quitting smoking, engaging members and can in physical activity to properly managing email up total worker health behaviour as a way to reduce stress. significantly influence How to foster employee ownership and create public policy to help by Terry T-K Huang programmes that are worker centred is an area for greater innovation. We see in several case studies create an environment where employee participation in the design and that is conducive to implementation of programmes leads to greater engagement and more individually tailored healthy diets, physical services and benefits. activity, non-smoking The increasing awareness of the importance of workers’ health and the growing Several companies featured in the case studies investment in wellness programmes by employers in recent years represent an opportunity are multinational corporations that have the and other desirable for the private sector to innovate and to leave a larger footprint on public health. potential to exert a global impact on the health According to the 2015 survey on wellness programmes from Fidelity Investments and the of populations worldwide. For scaling up wellness health behaviours National Business Group on Health (NGBH), employer spending was expected to go from programmes and the diffusion of innovation, $430 per employee in 2010 to $693 per employee in 2015. This is a significant increase policy coordination, logistics, finances and cultural adaptation are all key factors. These are worthy of within a short period of time, and as shown by the five case studies from Barclays, DaVita, further study as the movement to expand workers’ Taking a systems approach also highlights HealthPartners, Unilever and GSK, this shift is driven to a great extent by the need for health continues to expand to small and medium- the potential role that companies can take to employers to decrease healthcare cost (especially in the U.S.), increase productivity, size companies around the world. In parts of the address factors related to policy and the built and recruit and retain top talents. Investing in workers’ health is no longer a luxury but a world where public health is weak, companies environment that help shape health behaviours and outcomes. Companies often have a larger business imperative. And increasingly, this will become a core value across businesses. can play a significant leadership role in building the public health capacity and coverage in those voice than individual community members and can regions. significantly influence public policy to help create The U.S. National Institute of Occupational Safety notably expanded from the traditionally core an environment that is conducive to healthy diets, and Health defines “Total Worker Health” as the features of employee wellness programmes to The Total Worker Health concept implies a physical activity, non-smoking and other desirable integration of policies, programmes and practices incorporate elements of social, emotional and systems approach to employee wellness, where health behaviours. that collectively prevent worker injuries and financial health, consistent with the idea of “Total the next phase of innovation is less about In the field of public health, employee wellness is illnesses and promote worker wellbeing. Among Worker Health.” Social, emotional and financial individual programme components but more now emerging to become a focus area. This is a wellness programmes across 121 companies, the aspects of health are important dimensions about intervening directly in the ecology of a great opportunity for public health researchers Fidelity/NGBH survey found that the three most of quality of life and important predictors of worker’s being. This takes us beyond the individual and companies to work together to evaluate common strategies employed were biometric morbidity and mortality. employees to think about how employees’ family and improve wellness initiatives. For the most screenings (72%), health risk assessments members (e.g. children and aging parents) and A few other innovations are noted in the case part, companies continue to rely on process and (70%), and physical activity programmes (54%). communities are key to supporting the physical, studies. For example, the use of mobile health output measures to document impact. However, as Preventive screening and assessments certainly social, and mental health of the employees technology appears to be effective for incentivising evidenced by the case study from HealthPartners, remain a feature in the case studies presented, themselves. Some companies appear to be ahead engagement from employees (employee under- it is possible to extend such evaluation to health alongside work-related injury prevention. of the curve in addressing these dimensions and participation in wellness programmes remains and economic outcomes. Academic-private However, some programmes among the case are extending benefits and services to a broader a significant issue). In addition, research is fast partnerships can significantly improve the quality studies presented have incorporated increasingly population. advancing in showing how mobile technology and long-term impact of corporate wellness more sophisticated forms of case management can be used to harness health data to inform the programmes and add value to the investment of diseases. In addition, the programmes at quality improvement of programmes. made by employers. HealthPartners and Barclays, for example, have
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In conclusion, there is now clear business value to innovate and invest in employee wellness initiatives. The selected case studies show that companies are setting new trends in addressing non-medical aspects of health, such as social and financial wellbeing, in employee engagement, and in scaling up programmes globally to reach participants whose health can benefit from employer support even more than those in developed countries. However, we need more research to both innovate and evaluate wellness programmes. We also need implementation and dissemination research to identify ways to diffuse best practices within the Total Worker Health and systems approach framework so that they become the industry norm among not only large corporations but also small and medium-size companies.
Terry Huang Terry is a Professor of Community Health and Director of the Centre for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy.
He chaired the Department of Health Promotion at the University of Nebraska Medical Centre (UNMC) from 2010-2014. Prior to returning to academia, Dr Huang was a senior leader in the U.S. National Institutes of Health (NIH) on the integration of systems science and chronic disease prevention. Dr Huang is a global leader on systems-oriented community health, cross-sectoral partnerships, design thinking, collective impact, and the translation of science to policy. Dr Huang has lectured extensively on these topics and published over 100 articles. He is currently an international systems science advisor for the Victoria Department of Health and Human Services, The Australian Prevention Partnership Centre, and Deakin University. Dr Huang received the U.S. Department of Health and Human Services Secretary’s Innovation Award in 2010 and the NIH Director’s Award in 2011. In addition, he received the National Cancer Institute Award of Merit in 2012 and was named UNMC Distinguished Scientist in 2013. Dr Huang holds a PhD in Preventive Medicine and an MPH from the University of Southern California, and a BA in Psychology from McGill University.
He is Board Certified in Public Health (CPH) and Fellow, Councillor, and Past Programme Chair of The Obesity Society. He is also VP North America of the World Obesity Federation.
76 77 Digital inventions
Keeping our people and customers safe and informed by Lorna Friedman 80
Delivering workplace wellness via mobile tools by Ting Shih and Allen Hammond 84
Small steps big benefits: Walgreens rewards for healthy choices by Harry L. Leider 88
Live Well by Thomas L. Fariss and Stephanie Pereira da Silva 92
Lifestyle and health – empowering us all through smartphone technology by Shaun O’Hanlon 96
Commentary: Digital health technology by Scott Donohue 100
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In operation for a little over a The On Our Way Challenge: encouraged to form teams and to year, Bupa WATCH has recorded Getting our people connected get active in whatever way they Keeping our people over 5,000 incidents from around and moving chose for three weeks. Employees the world. These include natural Our people have told us in surveys ran, walked, biked, swam, practiced disasters, bombings, acts of they love working for a health care Tai Chi or yoga. The challenge and customers safe violence, and disease outbreaks. company because they like to was designed for inclusion and all These alerts have been filtered help others and they love working forms of activity were acceptable according to geography, severity, globally. They also report that as well as the syncing of a host and relevance to produce 45 they are stretched for time, can of personal devices. The social and informed targeted Bupa WATCH messages, feel overwhelmed, and want to be aspect of the challenge was widely resulting in action for those who more connected. So with 1,800 embraced with frequent postings need it. employees in 25 offices working that highlighted our diversity and by Lorna Friedman 24/7, how do we get them to take encouraged good fun. There was In some cases this action will the time to talk to one another, organised communication with consist of just a health warning, have fun and help themselves as daily updates on team scores while in other cases, such as the well as others? as well as weekly team and response to the swine flu epidemic individual prizes for participation, in St Petersburg, a tsunami in Our answer was the On Our improvement, and of course, best Bupa International’s global Despite being part of a large them on how to respond to the Chile, or the outbreak of the Way Challenge. We teamed up post. The campaign engaged health insurance business multinational, we feel more global health challenges they may Zika virus, Bupa WATCH has and texted, chatted, filmed, and 60% of our colleagues, and all of confront. We created Bupa WATCH instigated hands-on action such supports the health of like a small entrepreneurial selfied our way around the virtual Bupa International’s 25 locations enterprise and we face some to meet this need. as specialist support, evacuation, 2 million customers globe all the while raising money participated. unique challenges, including immunisations, or limits on travel. for our favourite causes. In May worldwide through This service is a true 21st century keeping remote teams connected, 2016 Bupa International ran an monitoring service designed to Bupa WATCH played a particularly access to over 1.2 million supporting individuals in high- internal wellness initiative, the On identify potential issues and risks important role in addressing medical providers, across performing roles with demanding Our Way Challenge. The three- for Bupa International customers the recent Zika outbreak, 190 countries. Our 1,800 global travel schedules, and week challenge was developed and employees related to natural highlighting the risks and helping those who care for others in response to our employees’ employees reflect the disasters, terrorism, pandemics, recommending actions for our to care for themselves. requests, identified through diversity and global and chemical radiation. U.S. and Latin American teams. Global People Survey results character of our customers. Bupa WATCH Health information and updates The service monitors many global and employee feedback through We operate 24/7 in 25 Bupa International, Bupa’s global are ongoing in impacted regions sources, including social media and #BupaGlobalCreates, employee health insurance business, has as well as support for mosquito offices, in over a dozen more established health care alerts focus group gatherings. well-established travel insurance, control in the workplace and the countries, speaking to identify issues and incidents evacuation, and repatriation home. Travellers to the region Most of our offices have existing multiple languages. in real time. A pre-determined services based in Copenhagen, are identified through our travel health offerings including on-site grading scale is applied to Denmark. Building on over 40 partner and warnings are issued gyms, healthy food options, and rate severity and impact of the years experience, the team has according to the destination. numerous locally-led initiatives. incidents. We then utilise our recently set up Bupa WATCH. The On Our Way Challenge was network of providers to validate In recognition of the value of this the first of its kind across all of and monitor the potential risks. service we were honoured when Our teams and our customers are Bupa International’s 25 offices. The Information with recommendations Bupa WATCH was awarded the in the air and commuting around initiative utilised our business tag are communicated to appropriate International Assistance Group the globe. As Global road warriors, line of On Our Way and had the recipients including customers, 2016 Award for Innovation. they are in need of fast and support of our most senior leaders risk managers, travel staff, accurate information that helps who made videos and actively facility managers, and of course, them make sense of the countless participated. Employees were social media updates and prepares employees.
80 81 The challenge saw brilliant engagement and behaviour change results with 93% of people saying they would continue the healthy lifestyle changes beyond the challenge, and participants achieved an average ‘active’ step count (8,000-10,000 steps a day). In total, the participants moved over 121,000 km which allowed us to donate $10,000 to charitable organisations. Dr Lorna Friedman Lastly, the employee engagement surveys found a higher number of Dr Friedman is the Director of Health Benefits and Medical for employees recommending Bupa as Bupa International. a place to work, and many positive comments about how they felt Her remit includes medical they were part of the larger team. policy and network operations. Dr Friedman is a graduate of New York Medical College and obtained an MBA at the Graduate School of Business at Columbia University. Originally trained as a paediatrician, Dr Friedman has held academic and teaching positions at University of Pennsylvania and Cornell Medical College.
Her business career includes time at Cigna, Emblem and prior to joining Bupa Dr Friedman was the Head of Global Health and the Human Resource consulting firm Mercer. In addition Dr Friedman has served on several boards with a focus on improving access to health including the Global Business Group on Health, The American Council on Exercise and the March of Dimes.
82 83 Digital inventions
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Case studies
Delivering workplace Vitalness@Work: Improve health Community task shifting to screen Scaling disease management through behaviour change and manage chronic diseases modules training In Mexico, student interns were The ClickMedix system delivers wellness via mobile tools Wellness services are extremely trained to screen children and these tools in multiple countries difficult to provide effectively in a adults at schools and community and languages (it is already clinical context, but can readily be centres for diabetes, hypertension, available in English, Spanish, by Ting Shih and Allen Hammond delivered both at the workplace obesity and renal disease, Arabic, and Chinese). It has been and to the employee’s personal identifying high risk patients and used in outreach community smartphone by the ClickMedix their families based on health screening, in-clinic disease platform. The Vitalness for All information collected on site. Over management, and hospital after- team is working with social the course of a short six-month care programmes; in partnership entrepreneur, Susan Pick, who pilot, 246 patients were screened with Medtronic for diabetes, heart Consumers increasingly link ClickMedix is a healthcare These characteristics enable the has developed a very effective using ClickMedix Telehealth disease, hypertension and ear to their social networks, technology company born out ClickMedix mobile platform to training method to empower Platform by three student interns. infections. The platform currently watch sports events, and of MIT. Since 2007, founder of screen large populations quickly, and enable people to change Using ClickMedix’s intelligent serves more than 250,000 ClickMedix has set out to create in the workplace, and to identify get news updates via behaviours. Her organisation, triage and referral system, 57% patients. ClickMedix can expedite a healthcare delivery platform individuals at risk of chronic smart mobile devices. So Yo Quiero, Yo Puedo (If I want of the people screened were improvement of health outcomes powered by mobile phones and conditions such as diabetes, to, I can), has trained over 20 identified with at least one and shift costs towards workplace it should not be surprising web that can improve the health hypertension, and heart disease, million people to improve health undiagnosed chronic condition or community-based care, while that mobile tools are likely outcomes of over a billion people. enabling early intervention. The outcomes through behaviour and referred for follow-up. referring patients who need more to play a major role in the It has implemented mobile health screening process can include changes. Susan and the Vitalness The intervention increased the acute care at an earlier stage of future of health – both in programmes in 16 countries collecting medical history as well Network are now applying this utilisation of primary care disease illness. with governments, hospitals, as measuring blood glucose, illness care and especially behaviour change process in management services by 70%. medical institutions, community blood pressure, and weight, in wellness services. This partnership with employers of health organisations, home care while referring patient at risk for low-income workers, screening trend will only accelerate agencies, and employers – even further assessment and treatment. for active and prospective illness as smart mobile devices in rural environments with limited The ClickMedix platform also and then training employees at and the cloud-based digital communications infrastructure and provides patient education/advice the workplace to adopt healthier platforms to which they connectivity. information, tracks diagnosis and lifestyles – to lose weight, stop treatment plan, and monitors smoking, improve diets, reduce connect become more The ClickMedix platform utilises follow-up and patient compliance stress, etc. The trainers, who also powerful and pervasive. the screen-diagnose-treat-follow with the treatment plan – all at the double as health caseworkers, Mobile tools are likely to play a up sequence in a workflow workplace. can follow protocols on tablets protocol - readily customised major role in the future of health – provided by ClickMedix and for any disease and designed to use mobile diagnostic tools for guide a front-line care giver in a both in illness care and especially screening. Cases of active illness hospital or clinic, in a workplace are referred to appropriate in wellness services or community, or other field medical institutions and can be environment. The platform is tracked via mobile phones and designed to integrate mobile tablets. Employers expect to diagnostics devices and to interact benefit from reduced absenteeism easily with medical records and higher productivity. systems, payment systems, and follow up programmes.
84 85 Ting Shih Dr Allen Hammond Ting founded ClickMedix, an Allen is a serial entrepreneur, award-winning healthcare a widely published author, technology enterprise born and a leader in market-based out of MIT Media Lab to enable solutions to poverty. He health organisations to serve currently leads a global network more patients through its eHealth of social entrepreneurs and platform. Her areas of expertise health professionals, Vitalness include mHealth solution design, for All, that seeks to catalyse competitive strategy, lean/Six a transformation of healthcare Sigma process improvement and systems from a nearly exclusive operations management. focus on illness care to a focus on prevention and enabling people She spent five years to live at their full capacity- implementing mobile health vitalness. Earlier, Dr Hammond programmes across 15 countries helped to launch the base of in North America, South the pyramid (BOP) movement America, Africa, and Asia to that transformed how large develop financially sustainable companies and the international health programmes through development community address ClickMedix. The programmes poverty. equipped health workers, nurses, pharmacists, and physicians with Dr Hammond has published smartphones to capture patient extensively, including articles in symptoms information, images, Foreign Affairs, Foreign Policy, and other related health data and the Harvard Business Review. to be transmitted to remote He has served as a consultant to specialists who can provide the White House science office, diagnosis and treatment advice. to several U.S. federal agencies, to the United Nations, to a number Ting is named Toyota Mother of major corporations, and to of Invention in 2015. She is several private foundations. He the Cartier Women’s Initiative holds degrees from Stanford Laureate 2012 for North America. and Harvard Universities She holds an MBA and MS in in engineering and applied Systems Engineering from mathematics. MIT. In addition, she holds a BS in Computer Science and MS in Software Design and Management from Carnegie Mellon University.
86 87 Digital inventions Member of the Network
Small steps big benefits: With 81 million members, Balance® Rewards is America’s largest loyalty programme and to date Walgreens rewards for has reached the following milestones: healthy choices • 250,000 connected devices • 1.5 million goals set by Harry L. Leider • 73 million miles logged • 1.9 billion points awarded
Preventable illnesses can Improving workforce health and small, easy-to-achieve steps – such result when people ignore lifestyle behaviours may lead to: as taking one walk, monitoring blood pressure one time, or eating Points can be redeemed like cash at Walgreens At Walgreens we value and understand the personal risk factors • Lower medical and disability one healthy meal – that, when locations, Duane Reade stores and at importance of our employees and associates such as nutrition, weight claims added together over a week, a Walgreens.com. Plus every visit to Walgreens, own health and wellbeing. It is for this reason we Duane Reade or Walgreens.com gives participants control, exercise, blood • Decrease unplanned sickness year or a lifetime, can lead to major incentivise and motivate our staff by offering them lifestyle changes. access to experienced pharmacists and thousands double reward points for their healthy behaviours. pressure and smoking. • Reduce absence of product offerings that support healthier lifestyle By promoting healthy Participants earn virtual reward • Increase productivity choices. We are proud of our current employee involvement lifestyle choices, health points for healthy activities such and strive to build on this year on year: Participants also have access to Your Digital Health plans, employers and Employers with highly effective, as 250 points for setting their easily accessible programmes that first healthy goal, 100 point for Advisor, an online resource that provides a digital 2015 payers can take a positive contribute to improved workforce an immunisation or prescription coaching experience similar to one-on-one health • Period 1: 1.83 billion points earned by 45,800 step toward reducing health report 34% higher revenue and 20 points for more routine coaching. team members (45% participation) activities such as weight, blood healthcare costs. per employee and market Balance Rewards is different to other workplace pressure and glucose tracking • Period 2: 1.50 billion points earned by 37,600 premiums that are 20 percentage health programmes as it is allows the following: points higher than ineffective or physical activity. In addition, team members (37% participation) recognising and embracing the companies. Unfortunately, lifestyle 1. Frequent rewards: Members are rewarded • Period 3: 1.55 billion points earned by 38,500 power of today’s digital health behaviours related to health risk for small activities that they can log each day team members (38% participation) factors such as eating, exercising era, participants can connect a through Balance Rewards for healthy choices® and smoking, are among the most favourite health or fitness device 2016 – Changed to two periods online or through the Walgreens 2. Options, options, options: Points can be challenging to modify. However, • Period 1: 1.80 billion points earned by 45,000 App and earn themselves an extra redeemed for thousands of healthy products in incentives can help motivate team members (44% participation) members to initiate and participate 250 points. They are then able to our stores or online in healthy activities. track their progress and points • Period 2: 1.85 billion points earned by 46,300 3. Cost effective: You fund only the points earned. earned on their desktops, tablets team members (45% participation) Walgreens Balance Rewards for or mobile devices. There are no per-member per-month charges or healthy choices® utilises incentives, administrative fees goal setting and regular self- 4. Prov en engagement over time: Balance monitoring to inspire and motivate Rewards boasts an outstanding record of participants. The programme engagement, month after month. In fact, over is built on evidence-based 70% of members with a connected device were methodology that incorporates still active 12 months after joining
5. Flexibility with your current programmes: Balance Rewards can be seamlessly integrated through your existing wellness portal. 88 89 Digital inventions
The programme has produced the following results: Better medication adherence to antihypertension medications A study with 4,943 new participants of the Balance Rewards for healthy choices® programme found higher levels of adherence, measured using PDC, in those who tracked blood pressure.
Significant weight loss In a study of over 100,000 participants: 2.6 percentage Adherence rate of participants who points tracked blood pressure levels higher 100% of participants lost an average of 3.3 81.7% pounds
Adherence rate of participants who 27.2% of participants lost more than 6.0 did not track blood pressure levels pounds 79.1% p<0.004 16.5% of participants lost more than 10.0 pounds 2.4 percentage points Participants who Adherence rate of participants who higher logged more than 1 mile per day logged at least 1 mile a day lost an average of 3.7 pounds 81.5%
Adherence rate of participants who Better adherence to oral diabetes medications logged less than 1 mile per day A study with 1,855 new participants of the Balance Rewards for healthy choices® programme 79.1% found adherence, measured using proportion of days covered (PDC), improved substantially. p<0.048 5.4 percentage Adherence rate of participants who points higher tracked blood glucose levels 82.9% Harry L. Leider Harry Leider, MD, MBA has over 25 years experience as a physician executive in a variety of innovative healthcare organisations. As Chief Medical Officer and a Adherence rate of participants who Group Vice President of Walgreens, he is responsible for developing enterprise- wide health and wellness services that provide customer value and improve did not track blood glucose levels 77.5% patients’ lives. Prior to joining Walgreens, Dr Leider was Chief Medical Officer and Senior Vice President of Ameritox, a national laboratory that provides p<0.001 7.9 medication monitoring services to physicians that treat chronic pain and serious percentage mental illness. points In addition to his extensive background in population health, Dr Leider has broad Adherence rate of participants who higher experience in managed care. He served as Chief Medical Officer at XLHealth, logged more than 1 mile per day 86.4% a Population Health company and Medicare health plan that served seniors with chronic illnesses. Previously he was Chief Medical Officer for HealthNet, a hospital-owned managed care organisation and a physician executive at Harvard Pilgrim Health Plan. Adherence rate of participants who logged less than 1 mile per day 78.5% p<0.001
90 91 Digital inventions Member of the Network
Live Well by Thomas L. Fariss and Stephanie Pereira da Silva
In 2014 Kimberly-Clark introduced the Live Well Challenge. Participation in the Live Well Challenge was targeted to a subset of U.S. Kimberly-Clark employee population, and was comprised of an integrated activity and weight management based programme design.
Employees throughout the U.S. completed an Participants returned during fourth quarter 2014 to initial health screening at programme inception repeat the fitness assessment and evaluate results that included: a customised laboratory panel achieved and degree of completion in reaching that included lipids, complete blood count, and individual targeted goals over the course of the metabolic panel; a fitness assessment with pre- programme. programme vital sign and biometric measurements, The programme was designed to increase strength, flexibility and VO2 testing; and a health individual awareness of actual and perceived levels coaching session with a Registered Nurse to review of personal physical activity, alongside promotion all results and identify individual participant goals. of current recommendations for daily activity levels Initial screening results and goals would be tracked necessary to improve fitness and decrease health for participants and compared against post- risks. programme results. All participants were provided A significant portion of the Kimberly-Clark a Fitbit® at no cost to the employee for tracking employee population have sedentary jobs that daily physical activity, sleep, and nutritional data. includes sitting at a desk for a majority of the In addition to tracking via the Fitbit® dashboard, working day, or standing in one place without individuals also self-reported participation in much variation in position. other physical activity challenges throughout the year, such as the National Health and Fitness Many employees also have a sedentary lifestyle Day, personal fitness time, Get Up and Ride (a outside of the work environment. In 2014 Fitbit® U.S. companywide bicycling challenge) and other was a new and exciting wearable device that promoted activities. Kimberly-Clark also provides was discrete with the capacity to provide real an onsite fitness centre for employees to utilise at time tracking of activity. Kimberly-Clark received no-cost, and includes a provision for the spouses leadership support to distribute approximately of employees to utilise the centre for a nominal 3,500 devices (at no charge) to employees annual fee. participating in the Live Well Challenge. Inclusion of this incentive contributed to increased A points programme was created and participants programme visibility, and generated excitement were awarded points for each activity completed by employees eager to begin participating. to support reaching a personalised health goal.
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The main challenge of this Multiple individual participants Kimberly-Clark continues to intervention was to maintain successfully achieved health promote multiple activity devices Thomas L. Fariss, MD, MPH employee engagement as improvements as evidenced by at discounted prices to support Thomas L. Fariss is currently Corporate Medical Director at Kimberly-Clark the programme progressed. laboratory results, biometrics, self-monitoring of physical Corporation, responsible for medical affairs and employee health services Tracking of participant activity attainment of personal goals, such activity and other health data for the company. Dr Fariss joined Kimberly-Clark in 1994 as Regional Medical was completed via the Fitbit® as weight loss of 30-100 pounds. by the individual. Additionally, Director in Neenah. dashboard, which revealed through our Next Jump platform Of the participants who completed Dr Fariss graduated from the College of William and Mary with a Bachelor decreasing participation and at Kimberly-Clark employees the programme the following of Science degree in Chemistry in 1983, and received his medical degree activity levels as the programme can receive discounts on gym outcomes were achieved: 47% from University of Virginia School of Medicine in 1987. He served his internal progressed. memberships as well as health (525) participants demonstrated medicine internship and residency at Georgetown University Hospital in and fitness equipment. Washington, DC. In response to the decreasing a measurable improvement in their activity, monthly step challenges individual cardio scores; 51% of Kimberly-Clark is ready and In 1994, Dr Fariss completed his Occupational and Environmental Medicine Residency and Master of Public Health were implemented to keep (567) participants increased their willing to support and learn from degree at George Washington University in Washington, DC. participants motivated and flexibility; and 4% (48) lowered other companies in building such engaged in the programme. their blood pressure. programmes: sharing of best He is board certified in Internal Medicine, Preventive Medicine/Occupational Medicine, and is a member of several professional societies. practices, future trends, research, Programme implementation Long term plans for the Kimberly- successful interventions and Dr Fariss is based at Kimberly-Clark’s operating headquarters in Roswell, GA. Special interests include preventive included 3,424 U.S. participants Clark wellness programme are to programme designs used by others health, fitness, and tennis. He is originally from Roanoke, VA. He and his wife, Margaret, have two children. that were enrolled in the Live continue to explore innovative to influence and support positive Well Challenge and completed ways to encourage increased change. We are particularly the initial health screening at the fitness and movement among interested in benchmarking and beginning of 2014. Of the initial employees and to develop comparing strategies and data Stephanie Pereira da Silva 3,424 participants, 32 percent effective programmes that lead with medical teams from other (1,107 participants) completed the to healthy behaviours and an organisations doing similar work. Stephanie Pereira da Silva graduated from the University of Wisconsin Stevens programme in its entirely, including organisational culture of health. Point with a Master of Science in Human and Community Resources and the post-programme health Nutrition, a Bachelor of Science in Health Promotion and Wellness and minor in screening offered one-year after Nutrition. the programme was implemented. Stephanie has been with Kimberly-Clark for over eight years, specialising in the development, coordination, administration and management of the health and wellness programming for employees across the globe. Prior to Kimberly-Clark, Stephanie served as a Health Promotion Specialist at WPS Health Insurance; Aquatics and Preschool Fitness Director and Health and Wellness Coordinator at Sentry Insurance.
Stephanie is a WELCOA Platinum Well Workplace recipient, NBGH Platinum Award winner, AHA Fit Friendly Business Gold Award winner, Wisconsin Governor’s Gold Award and Bike Friendly Business Gold Award winner.
The programme was designed to increase individual Stephanie is a member of the Wellness Council of Wisconsin, American College of Sports Medicine, National awareness of actual and perceived levels of personal Commission for Health Education Credentialing and IDEA Health and Fitness Association. physical activity
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Lifestyle and health – empowering us all through smartphone technology by Shaun O’Hanlon (Pamela Taylor, practice nurse, Angela Howard and Dr Walling)
EMIS Group specialises in enterprise Based on the work we did with Apple, we have Angela, who lives in Crossgates, Leeds, said: “I’m “Obviously, we’ll keep an eye on things over time health management systems (EPR’s) integrated data from patients home blood pressure diabetic but have generally good health. I was and the situation may change. But for now, it’s primarily for the NHS in the UK, but we monitors with medical records to launch an app tested with really high blood pressure during one really promising.” using Apple HealthKit. This pilot study aimed of my routine check ups. also have over 20 million unique visitors Dr Walling said the PHR could enable GPs to make to tackle ‘White Coat Syndrome’ - the medical “Unfortunately, the medication I was given made better informed decisions when treating patients to our Patient.info website from around phenomenon responsible for sending some me feel quite ill and I was determined to prove that with a range of problems, including asthma, the world. Joining up the lifestyle and patients’ blood pressure soaring when they visit a I didn’t really need to use it. diabetes and weight issues. health systems has enabled us to create GP surgery. some truly innovative online solutions “Taking part in this trial has been brilliant because EMIS Health’s personal health record – integrated As part of the pilot study, Angela Howard (a it has proven that I don’t really have high blood with Apple’s HealthKit – enables patients in the which may be of as much use to patient) was able to prove that her surgery blood pressure and can now get on with doing the things UK to manage their own health in partnership with employers and employees as they are to pressure (BP) was uncharacteristically high when I want to do in order to improve my health, such as their GP and other health professionals. Patients patients and those who care for them. she visited the surgery and was not an accurate going to the gym. connect with their PHR via the Patient Access reflection of her BP at home. This was proven over smartphone app, which can also be used to book a month-long trial of the Personal Health Record “I’d recommend using this Personal Health Record GP appointments and view life-long medical (PHR) within EMIS Health’s Patient Access app. to anyone. It’s so easy to use and it has provided records. More than 13,500 users have logged Using an iHealth blood pressure cuff connected to me with real peace of mind.” 4.4 million pieces of information since the PHR an Apple iPhone, Angela collected blood pressure was launched last year. readings at home and shared them electronically Commenting on the findings, Dr Walling said that with Dr Alistair Walling, her GP at the Ashfield Angela’s medical history made her the perfect Medical Centre in Leeds, UK. patient to trial using the Personal Health Record from EMIS Health as a solution for White Coat The results of Angela’s blood pressure tests taken Syndrome. at home were normal, confirming that she did not need further treatment. Also known as White “The outcome of this trial was really pleasing both Coat Hypertension, those with the condition for Angela and for us,” he added. “ We found that only provide blood pressure readings considered the readings that she was taking at home were unhealthy within a clinical setting such as a within normal limits. hospital ward, clinic and GP surgery. Clinicians believe that it is caused by anxiety about having a medical appointment. 96 97 Digital inventions
I very much believe that we are at the very start of a new paradigm of healthcare where patients have more control, empowerment and even responsibility for their health; a new change underpinned by easy to use, low cost, accessible technology. We may not see the ‘uber-ifiaction; in health however we will see significant disintermediation and disruption through the empowered patient seeking healthcare though new Shaun O’Hanlon channels via their smartphone. This EMIS Group’s Chief Medical will extend to employee health Officer. Shaun started with EMIS also; as CMOs will be able to offer in 2005 and was responsible our employees unique healthcare for the clinical architecture of and lifestyle support – whether EMIS’s flagship product EMIS that be a video platform to enable Web, overseeing the roll out access to clinicians or other to GP’s and the inception and support services, personalised delivery of EMIS Mobile as well apps to support healthy minds as the community product. With the expansion of EMIS Group initiatives or holistic health to include pharmacy, hospital e-assistants who use intelligent care and service provision, nudges and direct intervention to Shaun has taken group wide support our employees. responsibility for product and clinical strategy. He is passionate The initiative described here is an about citizen healthcare and how example of how we can connect technology can empower the ‘PHR’s to enterprise level, clinically citizen through access to quality focused EPRs to provide a better healthcare information, access health experience to the patient to their own health record and and employee. the ability to share their personal health data with those caring for them. Shaun’s advanced work on EMIS Web has pioneered the next generation of clinical management tools within the UK healthcare market.
He trained at Cambridge and St Thomas’ Hospital, becoming a GP principle in 1994. Shaun is also a director of Qresearch.
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Similar to Kimberly Clark’s programme, Wallgreens created the Balance Rewards for healthy choices® programme to provide incentives to consumers who can earn points for healthy behaviours that ultimately Commentary: can be redeemed for thousands of health products at Walgreens locations. The programme provides points for simple behaviours such as filling a prescription or getting an immunisation, in addition to incentivising the use of digital health technology by providing points for using a health app, fitness device or connecting to a Digital health technology glucometer or blood pressure monitor.
by Scott Donohue
As with almost every other facet have all seized upon different recognises the sedentary lifestyle of life, digital technology is digital health technologies to that many modern workplaces revolutionising the way people advance their respective business promote and seeks to use digital interact with their health. Digital objectives, while also improving health technology as a way health technology, often defined as the health of their employees and to make people aware of just “the convergence of the digital and customers. how much it adversely affects genomic revolutions with health, their health. Kimberly-Clark’s Employers are increasingly relying healthcare, living, and society,” is programme, which also included on digital health technologies changing how employers engage a health coaching session, access as they continually seek out their employees around workplace to an onsite fitness facility, and new methods to engage their health initiatives, how healthcare several company-sponsored employees around workplace providers treat their patients, how fitness activities, engaged over health initiatives. Many employers governments raise individuals’ 3,000 employees and resulted have created programmes that awareness and engagement in in hundreds of employees use the concept of the “quantified public health issues, and how demonstrating improvement in self” – the practice of tracking individuals monitor and manage their cardio fitness, flexibility and analysing personal data. their own wellbeing on a daily and/or blood pressure. With Examples of the “quantified self” basis. In 2015, the global digital physically inactive employees are wearable devices such as health market was estimated to be costing employers an additional fitness trackers and smartwatches $76.7 billion and on pace to grow 26 cents per hour worked as a that are capable of capturing at a compound annual growth rate result of increased sick days, many information related to someone’s of 21% over the next six years. This employers have undertaken similar daily physical activity, as well as is no surprise – the widespread efforts that leverage the idea of sleep and nutritional habits. In one presence of digital health is the “quantified self” to change of the case studies, Kimberly-Clark, inescapable. The five case studies employee behaviours. Kimberly- through its Live Well Challenge, in this chapter are representative Clark, like many other employers distributed Fitbits to employees of the myriad ways in which piloting programmes centred at no cost in order to incentivise digital health technology is being around digital health technology, is employee participation in the utilised across the CMO Network. now challenged with how to create company’s activity and weight Walgreens, ClickMedix, Bupa, an enabling work environment that management programme. This Kimberly-Clark and EMIS Group allows employees to sustain newly programme, like many other acquired health habits. workplace health initiatives,
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Using the Your Digital Health Advisor, an online easily transmit the data to their provider, thereby resource that provides digital health coaching, creating a dataset not impacted by the sometimes programme participants can also use digital health stressful environment of a physician’s office. Digital technology is technology to track progress against health goals By allowing patients to capture relevant health revolutionising the way people and receive personalised guidance to assist in information in their homes, mHealth technologies their efforts. The Balance Rewards programme offer healthcare providers an entirely new interact with their health can be integrated by employers into existing dimension in which to interact with patients. In employee wellness programmes and has already one study, use of mHealth solutions by community demonstrated widespread results with participants. health nurses in the UK was found to decrease It is a great example of a consumer-facing paperwork by 60%, increase patient face time by However, in emerging economies, those numbers are 54% and 37% programme that uses a combination of incentives 29% and enable two more patients to be seen per respectively, indicating that there is substantial room for growth. Healthcare and digital health technology to promote healthy day. Telehealth solutions that allow patients to providers have shown themselves as willing to embrace the benefits of behaviour. virtually connect with healthcare providers have digital health and this will only expedite the uptake of many of the digital been found to significantly decrease hospital health solutions mentioned throughout the case studies. Bupa International, through its WATCH program, admissions, hospital bed days and trips to the has used digital technology to create a monitoring emergency department. Such digital health With no end to the rise of digital health in sight, employers looking to service to proactively identify potential incidents solutions are therefore capable of not only improve employee productivity would be well-served to think about how around the world for employees as well its improving health outcomes but also decreasing the digital health can be integrated effectively into workplace health initiatives. private medical insurance customers. Through costs to the healthcare system. tracking natural disasters, terrorism, pandemics and other issues that can pose serious health Digital health technologies that allow for threats – and then communicating these threats interoperability – seamlessly connecting many to users – the WATCH system represents another different data sources – have proven to be Scott Donohue form of digital health technology that is capable especially useful for healthcare providers. As Scott Donohue is a Vice President at of advancing core business objectives while also the digital health market continues to grow at a Rabin Martin where he leads the firm’s protecting employee and customer health. The rapid pace, with many new technologies being business development efforts and creates program not only identifies potential hotspots introduced every year, there is an increased need strategies to use the power of health but also recommends actionable steps that can for platforms that are capable of serving as a hub policy and advocacy to advance both client and global public health agendas. be taken by those affected. As with some of the for all of the information being collected. One Scott has extensive experience in other examples of digital health technology in case study details how ClickMedix has designed working across health policy, economics, this section, it answers the “So what?” question a mobile platform that is able to assist front-line market access and public health with a that often accompanies access to digital health providers in every aspect of patient care – from focus on increasing access to healthcare, information. screening to diagnosis to treatment and follow up. in the U.S. and global markets. The ClickMedix mobile platform applies a holistic Other companies highlighted in the case studies approach to healthcare delivery by creating a tool Before joining Rabin Martin, Scott was a Vice President, Global Sector Development at Edelman where he helped to operationalise the firm’s global have developed digital health technology to assist that can be used in a number of different settings, health sector strategy. Prior to Edelman, Scott worked at the Kinetix Group providers in managing patients, even outside the including the workplace. These types of digital as a consultant where he worked with clients from throughout the healthcare four walls of the physician’s office. For example, health technologies go one step further than EMIS Group’s Personal Health Record – industry in adapting their business models for the implementation of the some of the aforementioned examples in that they Affordable Care Act. Scott received a BA in Sociology and Anthropology from a smartphone app that is compatible with collect data and then make recommendations – Colgate University and an MPA in Health Policy and Management from New medical devices such as blood pressure in the form of health protocols, treatment plans, York University. cuffs – is emblematic of the many ways that and patient education – that provide tailored and mHealth (mobile health) can be used to improve actionable next steps for users. healthcare delivery and increase patient engagement in self-care. In the example of EMIS The digital health market is booming and yet both Group, their mobile technology enabled a patient healthcare providers and consumers still want to track their blood pressure while at home and more. In advanced economies, 87% of adults use the internet and 67% of adults own a smartphone.
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Hearts at work Bupa’s perspective Dr Paul Zollinger-Read 106
World Heart Day – hearts at work The World Heart Federation’s perspective by Rachel Shaw 108
Improving the health and wellness of our members, one step at a time by Aaron Smith-McLallen and Richard L. Snyder 112
Case studies from Blue Cross Blue Shield by Trent Haywood 116
Commentary: Mass participation and sustaining engagement in preventative health interventions by Phil Veasey, Reshma Patel and Dr Sonia Fihosy 120
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Sales teams promoted the check to corporate Bupa believes that such an evidence based, customers; creating a ‘campaign in a box – a suite easily accessible and understandable mass Hearts at work of resources for corporates to run their own heart participation based campaign can serve health campaign in their workplace. This included as a model for other companies to follow Bupa’s perspective collateral such as infographics and marketing in helping to stem the tide of global Non- materials. It has also been made available to Communicable Diseases. the Global CMO Network and presented at our by Dr Paul Zollinger-Read meetings. Over 235,460 people took the heart age check, through purely organic means via Bupa’s own channels, with no paid for promotion.
Globally the campaign saw a reach of 4 million and Both Bupa and the World Heart Federation submitted their perspectives on Hearts at Work and World Heart counting, with online content generating more than Day to demonstrate how businesses and NGOs can work effectively in partnership in tackling NCDs. These 53,000 views on Twitter and over 186,000 views case studies should therefore be read as a pair. on LinkedIn. Our most popular piece of single content was seen almost 50,000 times.
The tool has delivered proven improvements in 17.5 million people die The heart age check is a short, With workplace health such a health outcomes; studies demonstrate that heart simple question set which major focus for Bupa, we wanted each year from CVDs, an age checks motivate behaviour change and reduce calculates an individual’s heart to highlight specifically and give Paul Zollinger-Read estimated 31% of all deaths risk factors for heart disease, with no intervention age compared to their real age. advice on heart health in the In July 2012 Paul joined Bupa as their Global worldwide. As a global other than informing participants of their heart This is an easy, cost effective workplace. Chief Medical Officer. His role ensures that age. health and care provider, way to communicate individuals’ robust global systems of clinical governance Bupa businesses around the world Bupa’s purpose is longer, cardiovascular risk. The check is Based on Lopez-Gonzalez’s RCT each user who are in place, that Bupa commission and provide launched a news story examining healthier, happier lives, based on Framingham’s Heart Risk finds out their heart age will improve their heart services based on the latest clinical evidence how the heart health of employees and that they provide innovative models of care. and we are committed to study which calculates a user’s age by 1.5 years younger than their baseline in a varies in different job sectors Developing clinical relationships is an important probability of developing a CVD 12 month period. improving the health of based on 8,000 people who part of his role. event in 10 years. The tool uses this millions around the world. took the check in the UK, USA, algorithm which is supported by 1.5 x 131,000 = 353, 190 years Paul studied medicine at Cambridge University South Africa, Saudi, Australia, To raise awareness of heart health the World Heart Federation. of improved heart age and Guy’s hospital, before training as a GP in New Zealand, UAE, France, Hong in the workplace and to encourage Oxford. “Heart age” is an estimate of the Kong, Spain, Chile, India, Thailand, This makes the tool an evidence-based CVD people everywhere to adopt age of a person with the same China, Poland and Sweden. The secondary prevention tool. After working with the NHS Modernisation healthy behaviours at work, we predicted risk but with all other tool required localisation including Agency, he set up and became CEO of one of the launched a campaign targeting risk factor levels within normal translation and endorsement from By asking users to commit to improving their first Care Trusts in the country, merging health workplaces, employers and ranges. local heart federations. heart health, the tool is an evidence-based CVD and adult social care. employees. secondary prevention tool and is genuinely The tool is effective as risk Within Bupa, employees hosted improving the health of thousands of users. Paul went on to be CEO of several PCTs, CEO The campaign ‘Hearts at Work’ of NHS Cambridgeshire and CEP of NHS perception plays an important role interactive booths to get launched in Bupa’s key markets on Peterborough. in health behaviour – ‘intention employees engaged on their The World Heart Federation saw an up-tick of World Heart Day 2015, to capitalise 109% to its website visits on World Heart Day as to change’ and translates into heart health internationally. The Paul has also served as Medical Advisor and on a time when public awareness part of this campaign. lifestyle modifications that lead campaign also took over Bupa’s Primary Care Advisor for the Kings Fund and of heart health would be high. led the development of Clinical Commissioning to improvements in CVD risk. It is global intranet which has 11,500 The tool continues to build momentum with an Groups for the East and Midlands Strategic Bupa created a bespoke also more effective at impacting users, featuring infographics, extra 47,000 consumers taking it just this year Health Authority. international ‘heart age check’ – individuals’ risk perceptions than heart-friendly facts and statistics with no additional promotion by Bupa. It has also a simple online tool which percentage risk scores. You can in the homepage carousel. Global been integrated into a workplace health initiative calculates an individual’s heart age take the check yourself by visiting spokespeople got involved in Bupa in Spain - Sanitas’ ‘Healthy Cities’ initiative. compared to their real age. www.bupaheartage.com. including the CEO and Board www.madridhealthycity.com. members.
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World Heart Day – No other heart age check examines the correlation between heart age and profession or gives advice hearts at work on heart health in the workplace The World Heart Federation’s perspective
by Rachel Shaw
Hearts at Work is a campaign to Knowing your ‘heart age’ helps Heart disease is the number one inform and improve on the improve perception of heart attack cause of death globally, and your An estimated third of all deaths The campaign targeted workplaces, employers correlation between workplaces or stroke risk, and provides risk can be reduced by stopping worldwide are from cardiovascular and employees and was launched in Bupa’s key and heart health. motivation to improve lifestyle. smoking, diet and exercise. disease (CVD). The World Heart markets on World Heart Day 2015, leveraging a day with high public awareness of heart health. Federation uses World Heart Day on Bupa created a customised global ‘heart age 29 September every year to raise 54 awareness of CVD and that 80% of check’ – a simple, user-friendly online tool which premature mortality caused by CVD is calculates an individual’s heart age compared to their real age. The test was designed to maximise preventable by addressing risk factors, engagement and to be a simple, cost-effective way such as harmful use of tobacco and to communicate individuals’ risk of heart disease, Visit www.bupaheartage.com to see your heart age, alcohol, unhealthy diet and physical using an evidence-based algorithm supported by and recommendations for how to lower it. inactivity. the WHF science team. www.bupaheartage.com.
In 2015, as part of our focus on heart-healthy No other heart age check examines the correlation environments, World Heart Day featured a ‘healthy between heart age and profession or gives advice heart choices where you WORK’ strand. This on heart health in the workplace. ‘Hearts at Definition and measurement of success involved partnering with Bupa to create ‘Hearts at Work’ took a global approach, and was tailored Over 235,460 people have taken the heart age check, with no paid for promotion. Globally, the campaign has Work’ in order to: to the user’s location, through translation and reached 4 million people, with the majority referencing and raising awareness of the Bupa/WHF partnership. endorsement from World Heart Federation local Media highlights include the Daily Mail, CNBC, the Independent, the Australian (Australia’s leading national • Raise awareness of heart health in the workplace member organisations. newspaper), Telediario (evening news in Spain) and Cinco Dias (the second financial newspaper readership in • Encourage employees to adopt heart healthy At the World Heart Federation we promoted the Spain), showing demonstrable increase of awareness of heart health in the workplace. behaviours at work calculator through our members networks, website Social content has generated more than 53,000 views on Twitter and over 186,000 views on LinkedIn. Our and database of past WHD supporters. Bupa • Create ‘global’ thought leadership assets for most popular piece of content was seen almost 50,000 times. Bupa businesses globally carried out internal communications including senior spokespeople promotion. The tool is adaptable and was used in Bupa Australia for a campaign with the Australian Cricket Team. It has • Promote the Bupa and WHF partnership, raising been integrated into the Sanitas Foundation (Bupa in Spain) and Spanish Heart Foundation (WHF member) We also partnered to carry out research examining awareness of World Heart Day. ‘Healthy Cities’ workplace health initiative www.madridhealthycity.com. Bupa in China also ran a competition the correlation between heart age and profession, on weibo, on World Heart Day, which engaged over a million users. producing an infographic which was carried on the World Heart Day website and is shown across.
108 109 Outcome The tool has delivered proven improvements in health outcomes of thousands of users; studies demonstrate that heart age checks motivate behaviour change and reduce risk factors for heart disease, with no intervention Rachel Shaw – Project other than informing Manager participants of their Rachel Shaw is a World Heart heart age. Federation (WHF) Project Manager who has run the By asking users to organisation’s World Heart Day commit to improving campaign for the last three years. their heart health, the Rachel works closely with WHF’s tool is an evidence- corporate partners to bring the based CVD secondary benefits of their insights and prevention tool. The tools to our global membership tool continues to build and wider audience of healthcare momentum with an professionals, civil society extra 47,000 consumers organisations and the general taking it during 2016 public. with no additional financial investment from Bupa or World Heart Federation.
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the programme, such as flyers On a twice-monthly basis, In all, 459 members enrolled in the and posters to promote the individual participants received programme (234 in the enhanced Improving the health and programme in the workplace, as small plastic feet tokens for every condition and 225 in the standard well as sample emails that can be 10,000 steps they walked and condition). Participants ranged used to encourage and motivate larger tokens for every 100,000 from age 19 to 77, averaging 49.5 wellness of our members, employees. Employer groups in steps walked – a fun, tangible years of age at baseline, and 56% the standard of care condition representation of what they had were female. were allowed to do as much or as achieved. Participants collected The results showed that in both little promotion as they wanted the tokens on a lanyard and could conditions 79% of people who one step at a time throughout the programme. Survey trade them in for prizes. These signed up for the programme measures and biometric screenings incentives were designed to participated (logged step counts) were administered at baseline and encourage individual participation. in the first week. By week 38, by Aaron Smith-McLallen, PhD and Richard L. Snyder, MD at three, six, and nine months after Also, by displaying their lanyard of 40% of those who signed up in baseline for participants in both feet tokens, participants created the enhanced condition were conditions. environmental cues conveying a still participating compared to social descriptive norm that people 24% of those in the standard Groups in the enhanced condition are participating and walking. received the tool kit plus several condition. During the nine-month At Independence Blue Participating in 30 minutes of Business, “enlisting social norms” other enhancements, including Participants also received programme, participants in the Cross, we understand that moderate physical activity at least allows us to “capitalise on the most walking challenges (i.e. Race worksite-specific walking maps for enhanced condition averaged 726 Around the Globe; Tour of US walks of at least one mile in the more steps per day compared to the cost to treat illness five times a week, such as a brisk powerful of human motivators.” walk, can result in significant health Cities; World Tour) with twice- vicinity of their place of work. Two those in the standard condition. and chronic disease is As a committed partner in benefits, like lowering the risk of monthly feedback showing members of the research team In fact, in weeks four through encouraging our members to increasing every year. developing cardiovascular disease, each employer group’s progress rated each walk using the CDC’s 32, participants in the enhanced be and stay healthy, we tested Studies show that more hypertension, and Type 2 diabetes. compared to the other groups Walkability Audit Tool to ensure condition averaged over 10,000 the effects of two worksite- than 50% of health costs In addition, walking is a simple (employer group names were the path was safe. The maps were steps a day while those in the based walking interventions are the result of unhealthy activity that can be performed masked). The walking challenges designed to help participants standard condition only attained a over a nine-month period based virtually anywhere, and even and feedback were designed to overcome the potential barrier of 10,000 step average during two of individual behaviour. By on three key results: sustained modest sustained improvement create group cohesiveness and a not knowing of a good and safe those weeks. We also showed that contrast, research also participation rates, average daily can be very effective for improving sense of competition with other place to walk. Although groups in a 1,000 step increase in average step counts, and biometric and shows that healthier health. participating groups. both conditions received biometric daily steps was associated with employees are more psychological outcomes. Rather screenings throughout the significant weight loss for both productive, take fewer These compelling factors make than using monetary incentives, programme, we believed ongoing men (-3.8 lbs.) and women (-2.1 walking an ideal healthy behaviour our intervention leveraged social sick days, and have less feedback related to health status lbs.), and reductions in body mass to encourage in worksite wellness psychological principles of social healthcare utilisation. Walking is a would also be a motivating factor index (-0.41 for men, -0.31 for programmes. norms, feedback, comparison, for continued participation and women). Higher step counts were and competition to improve increased walking. also associated with improvements For employers, the value of simple activity participation rates and increase in mood, having more energy, and worksite wellness programmes is walking behaviour. that can be higher ratings of overall health. closely associated with the number of employees who participate Using a cluster-randomised trial performed and stay engaged for a sustained design, we randomly selected period of time. For employees, the six qualifying employer groups virtually value of participation in wellness for participation and randomly programmes is typically tied to assigned each to one of two anywhere. financial incentives, though non- walking interventions. The three monetary incentives may also groups in the standard of care be very effective for eliciting condition were given a tool kit, sustained engagement. As Drs free and available to all employer Kevin Volpp and David Asch noted groups, that included instructions in the 2015 edition of Health: Our and resources for administering
112 113 Our study showed that the programme enhancements designed to create group cohesion, competition, and to incentivise individual behaviour using non-monetary rewards and social norms had a strong positive impact on sustained engagement and on walking behaviour. Our programme was not designed to identify the impact of each programme element on participation and walking, rather Aaron Smith-McLallen, PhD Richard L. Snyder, MD we opted to include a variety of Lead Research Scientist Rich Snyder is senior vice low-cost engagement mechanisms Aaron Smith-McLallen is a president and chief medical with the goal of engaging as many manager and lead researcher officer at Independence Blue employees as possible. scientist in the Informatics Cross. He is the company’s chief Division at Independence clinical spokesperson, and has Although our data does Blue Cross. Aaron leads the overall corporate responsibility not address this point, our Independence Advanced for medical, quality, pharmacy interactions with programme Analytics team and is responsible management, and all clinical policies and programmes. participants revealed that they for predictive modelling, programme evaluation, customer were motivated for different He leads Independence’s efforts and provider analytics, survey to improve the quality of patient reasons: Some wanted to development and analysis, care by transforming primary care improve their biometric and developing and managing delivery to the patient-centred screening numbers; others external research collaborations. medical home model, which were motivated by the inter- In this role Aaron has successfully focuses on a team approach group competition; some engaged experts in areas of to accessible, well-coordinated simply liked being part of the predictive modelling, health primary care, and promoting the group; and some were highly behaviour change, healthcare adoption of the accountable- motivated by the individual delivery, and health policy from care model among the provider rewards in the form of plastic a variety of academic institutions, community. including New York University, feet tokens. Incidentally, very He is active in a variety of the University of Pennsylvania, state and professional advisory few participants traded their Princeton University, and Drexel committees and is a member plastic feet tokens in for other University to collaborate on a of the AMA, the Pennsylvania prizes. The tokens were a wide range of research studies Medical Society, the American physical representation and aimed at improving healthcare Academy of Family Physicians, delivery and health outcomes. reminder of what they had and the Pennsylvania Academy accomplished, which was Aaron received his doctorate of Family Physicians. valued above more monetarily in Social Psychology from the Dr Snyder is a graduate of valuable prizes. University of Connecticut and Franklin and Marshall College joined Independence after and the Medical College of completing a three-year post- Pennsylvania. He is board- doctoral research fellowship certified by the American Board at The Annenberg School for of Family Medicine. Communication at the University of Pennsylvania.
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Blue Care Connection® Blue Shield of Blue Cross Blue Shield Case studies from Disease Management California of Tennessee Each Blue Care Connection® Wellness as Lifestyle Medicine Onlife Health and Liveon Portal Disease Management programme Wellvolution is the Blue Shield Onlife Health, a subsidiary of Blue is designed to: increase Blue Cross Blue Shield of California (BSC) wellness Cross Blue Shield of Tennessee participants’ understanding of programme that makes it easier (BCBST), is a population health their condition; improve their for employees and customers and wellness company with an by Trent Haywood ability to follow the treatment to develop and maintain a evidence-based approach to plan; help reduce complications; healthy lifestyle. Wellvolution behaviour change which leverages deliver educational materials, continues to use social media, healthy worksite consulting; including a quarterly newsletter, behavioural economics and intuitive, interactive technologies self-care goals agreement and care game theory to build tangible and personalised coaching to reminder cards; offer a dedicated wellness initiatives and improve help organisations improve The first step in participating toll-free number and online ahealthyme and Blue ahealthyme outcomes; and has introduced the health and productivity of in ahealthyme is to complete educational support. Care Connection Lifestyle Medicine to treat and their workforce. Onlife develops ahealthyme helps members the Health Assessment. Health Members who are living with a reverse chronic conditions such customised health and wellness Blue Cross Blue Shield of who want to improve their Assessment results are used to chronic condition may be able as diabetes and coronary artery solutions that combine health lifestyle habits or simply create a Personal Risk Report. Massachusetts (BCBSMA) to benefit from participating in disease. BSC collaborated with coaching, participant and improve their overall health This report not only provides ties its wellness and disease a Blue Care Connection® Disease leading academic institutions organisational engagement participants with an easy-to- management programmes, and wellbeing. ahealthyme Management programme. such as Harvard University and strategies (based on their understand explanation of their specifically ahealthyme and helps participants reach their These comprehensive, health the University of California – organisational assessment) and health status and any health Blue Care Connection® Disease individual health improvement management programmes are Berkeley to implement a number performance measurement tools risk factors they may have, but goals by providing them designed to help members with of different social networking to drive lifestyle improvement Management programmes, to it also helps ahealthyme create with personal wellness plans chronic conditions, including initiatives for its employees that and promote healthy living. the Alternative Quality individualised, tailored personal diabetes and conditions related to are beginning to re-define what’s These solutions are continuously Contract programme. and valuable tools designed wellness plans for each participant. cardiovascular disease, understand possible in wellness. Unlike most adapted based on measured to address each individual’s Depending on the health risks the day-to-day management of employers experimenting in this outcomes and the needs of the specific health needs. identified by the health report their condition, support their space, BSC and Wellvolution are population to drive the greatest and the specific goals included physician’s plan of care and looking to leverage emerging impact. Onlife has developed in the personal plan for health, improve their quality of life. social media tools to drive wellness solutions for several participants have a variety of tools Disease Management programmes concrete engagement and action population segments under BCBST and support to help them achieve provide individual self-assessment with respect to optimising diet management, including their fully- their health goals. These include: and educational tools, and, when and lifestyle choices. From self- insured business, BCBST employee wellness workshops for a variety appropriate, support by phone that organising wellness communities population and strategically of lifestyle risks; tracking tools enables participants to take a more to blogs to cutting edge team selected ASO accounts. These to monitor factors that influence active role in their own health challenges BSC is putting the solutions support BCBST’s health, such as exercise, nutritional management. WE in wellness. BSC Wellvolution health and wellness strategy that intake and health screening results; operates on a rapid prototyping focuses on preventing disease family wellness plans to encourage model. Ideate, implement, and promoting healthy living. healthy eating and physical activity measure, adapt and expand as Additionally, these programmes for children and more than 1,000 warranted. Wellvolution is a will were developed to support a healthy articles and recipes. and skill initiative. Limited financial cultural shift to a healthier work investment, limited staff time were force and the goal of becoming required. The programme engaged a model for successful wellness self-empowering employees to initiatives. lead the wellness initiative vs. a command and control structure.
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BCBS Michigan Healthy BlueLiving
Blue Care Network (BCN) of Michigan’s innovative wellness product, Healthy Blue Living, is a product developed to reward individuals for committing to healthy lifestyles. BCN’s Healthy Blue Living was first- to-market in Michigan with a product structure that encourages employees and their spouses to commit to healthy lifestyles with support from their primary care physicians and their Healthcare Management Organisation. Now, more than 500 businesses or groups have Healthy Blue Living. Healthy Blue Living encourages employers to offer a smoke-free work environment, promote physical activity at work and offer healthy food choices in vending machines and cafeterias. In addition to improving health, Healthy Blue Living rewards its members with lower co-payments and deductibles. To help them on their journey to wellness, members also have access to wellness and care management programmes and services; including smoking- cessation programmes and other online behaviour programmes through BlueHealth Connection®. BCBSM launched Healthy Blue Living Rewards, a new plan, which is a combination of participation and outcomes based measures, in October 2010. The rewards programme adds mid-level benefits with average co-pays and deductibles. BCBSM will continue to refine health measures to obtain optimum member health improvement.
Trent Haywood Trent Haywood, MD, JD, is president of the Blue Cross and Blue Shield Institute and chief medical officer for the Blue Cross Blue Shield Association (BCBSA), a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies. The Blue System is the nation’s largest health insurer covering over 107 million people – approximately one-in-three Americans.
As the Association’s chief medical officer, Dr Haywood supports the innovation of Blue Cross and Blue Shield companies in communities around the country as they improve the choices of healthcare quality and patient safety for their members. He is responsible for the Office of Clinical Affairs, which includes the Centre for Clinical Effectiveness, Centre for Clinical Practices, and the Centre for Clinical Value. Collectively, the Office of Clinical Affairs support opportunities between Blue Cross and Blue Shield companies and stakeholders to improve the choices of affordable, high quality healthcare provided to members.
Dr Haywood leads the National Council of Physician Executives (NCPE), which consists of chief medical officers and chief pharmacy executives that guide the clinical direction across BCBS companies. Dr Haywood provides clinical leadership for the 5.3 million-member Federal Employee Programme. In addition, Dr Haywood provides clinical guidance to Blue Health Intelligence, an independent licensee of the BCBSA.
Before joining BCBSA, Dr Haywood served as senior vice president and chief medical officer for VHA, Inc. where he developed best practices to drive quality, stimulate clinical innovation, support pay-for-performance, and prepared for consumer driven healthcare. Prior to joining VHA, Dr Haywood was deputy chief medical officer for the Centres for Medicare and Medicaid Services (CMS) where he led agency priorities including quality public reporting and value- based payment innovations.
Dr Haywood received a bachelor’s degree from the University of Notre Dame and a medical degree from the University of Illinois in Chicago. He completed his internal medicine residency at Loyola University. Dr Haywood also holds a law degree from Northwestern University School of Law.
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initiative paid due consideration The use of technology Capitalising on social dynamics to the sorts of barriers described Expensive public health mass and behavioural psychology Commentary: (e.g. personal safety) and helped media campaigns were common The case studies show that the participants to embrace this often in the past with varying degrees role of social psychological undervalued form of physical of success. In the current target- dynamics can be key to sustained Mass participation and activity. Additionally, targeting driven context of limited resources, engagement in preventative the workplace, schools and other the aim is to convey effective health interventions. Continued places where people are duty- health messages to as many engagement was shown to be bound to attend is a particularly people in the target population as more likely and more effective sustaining engagement effective strategy, cutting through possible in an affordable manner. when driven by supporting competing demands on their time The global reach of the internet, social processes which shift the and taking the message directly to popular social media applications, internal culture, such as social in preventative health where they live, work, or learn. specialised digital platforms conformity and social comparison. and mobile communications are In the reviewed studies, a ‘buzz’ obvious channels to this end. underpinned by shared interests, Additionally, validated, evidenced- was generated by those who had interventions Mass based online tools for primary and already taken in the part in the secondary prevention can play programme and this encouraged an important role in improving others within their networks to by Phil Veasey, Reshma Patel and Dr Sonia Fihosy participation the health of a population. join them. For example, employees initially relies These self-service methods are wanted to see how their ‘heart age’ cost-effective and may be best compared with colleagues, friends upon effective positioned for capturing valuable and relatives. data for monitoring, evaluation Positive reinforcement, a concept messages to and research purposes, which Overcoming barriers contradictory and/or distracting borrowed from behavioural Mass participation and could in turn, inform policy material, unconducive to a healthy encourage psychology and well-exploited now sustained engagement in On a daily basis, those living in and guidance. However, these lifestyle. by the electronic gaming industry, large-scale preventative an obesogenic environment are individuals forms of communications may required to avoid overly-frequent also played a significant role in health interventions are Furthermore, it appears that for exclude particular segments of consumption of unhealthy foods the walking initiative. Participants ultimate goals for the many currently ‘well’ individuals, and families to the target populations such as and drinks and to combat the were incentivised to stay with a reduction of their risk of chronic lower socio-economic groups champions of public health. inertia of habitual sedentary overcome such the programme by non-monetary disease in the distant future or those with limited literacy or The following emergent behaviours. They may find rewards. is not a sufficiently powerful computer skills, meaning that themes were identified themselves having to navigate barriers motivator for them to take those most in need could be unsafe outdoor spaces, drawing in the BUPA “Hearts at measures necessary now and missed. Therefore, the designers on limited time and sometimes, work” and Independence sustain them. These case studies of public health campaigns budgets in order to engage in the walking group case studies: demonstrate that an effective should identify such groups and recommended levels of regular overcoming barriers; the preventative health message develop adjunctive strategies to physical activity. Mass participation needs to be relevant, personalised, reach them. Furthermore, whilst astute use of technology; in healthy lifestyle interventions easily understood and able to some individuals will appreciate and capitalising on normal initially relies upon effective elicit a firm commitment to digital health messages and tools, messages to encourage individuals social dynamics and behaviour change which leads to there will always be others who and families to overcome such behavioural psychology. perceptible benefits in the here will prefer traditional personal barriers. However, this is proving Each of these themes will and now. For example, the concept interaction. difficult against the increasingly briefly below discussed. of ‘heart age’ was applicable to noisy backdrop of a 24-hour individuals at all ages and stages multitude of internet, social and provided a motivating goal and mas media communication to aim for with clear steps to channels which often deliver achieve it. Similarly, the walking
120 121 Phil Veasey – Marketing and Business Development Director, Mytime Active Phil has a track record of creating and scaling high impact, sustainable strategies and programmes in local communities including:
• Co-writing the recommendations underpinning the implementation of the Morgan Stanley ‘Healthy Cities London’ programme launched in February 2015 – www.morganstanley.com/healthycities/london.html
• The community sport element of the National School Sport Strategy, including ‘Sportivate’, for the Department of Culture, Media and Sport and the Department for Education, a £36m project that attracted 900,000 ‘unsporty’ young people into sport in a three-year period – and is now a major 2012 Olympic legacy programme
• The National Mini Tennis Programme, for the Lawn Tennis Association (now the way children are introduced to the sport globally)
Phil currently sits on the Public Health England National Child Measurement Programme Board.
A thought leader who speaks regularly at conferences and events including BBC breakfast and the European Obesity Forums in 2014 and 2015.
Reshma Patel – Lead Adult Dietitian Reshma Patel has a BSc Honours degree in Nutrition and Food Science, MSc/ Post Graduate Diploma in Human Nutrition and Dietetics, is a member of the British Dietetic Association and is a Registered Dietitian with six years’ experience in nutrition consultancy.
Reshma currently works for Mytime Active as the Adult Lead Dietitian and Specialist Weight Management Dietitian.
She has worked closely with the British Heart Foundation, Diabetes UK, Brent Council and many other corporate organisations in promoting health and wellbeing. Workplace heath and improving companies workforce by adhering to nutritional values is of particular interest to her. She specialises in child nutrition, weight management and the prevention of chronic conditions. Reshma’s passion, knowledge and enthusiasm for nutrition attracts requests for return presentations amongst her portfolio of individual, public and corporate clients.
Dr Sonia Fihosy – Head of Clinical and Research Services Dr Sonia Fihosy, is Head of Clinical and Research Services for Mytime Active, a leading healthy lifestyle social enterprise in the UK. She also practices as a Clinical Psychologist in multi-disciplinary weight management services provided by Mytime Active in inner London areas, working directly with children, adolescents and parents, including post-natal mums.
After achieving a Master’s degree in medical physics (IT), Sonia worked for over a decade as an investment banking systems professional on international projects. Seeking an entirely new challenge, she later re-trained to be a Chartered Clinical Psychologist with specialist interests in culture, physical health and wellbeing, particularly in adolescents and young adults. Sonia is married with an adult step-daughter and two teen-aged sons.
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Creating sustainable healthcare for low and middle income Commentary: populations in global growth Shaping the future: What kind markets: The Abraaj approach of healthcare economy do we by Bobby Prasad 126 want to leave for our children? by Al Mulley 140 Preparing workplaces to support staff affected by cancer by Liz Egan 128
Sustainable value and quality for employee health through a healthcare services contracts exchange by Dr Eric Silfen 132
Vitality: Improving health for its workforce, for the workplace and the community by Dr Derek Yach and Dr Cother Hajat 136
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be able to genuinely offer higher This entails developing city-based Undoubtedly, our work has been quality care on scale that is multi-specialty “hub-and-spoke” cut out for us but if we can Creating sustainable widely affordable and accessible healthcare ecosystems and super- proceed in a methodical, proactive to the mass market. Equally of specialty networks that provide and collaborative way with all of importance, these systems need to a coordinated set of healthcare our stakeholders then we have healthcare for low be sustainable in the long-term. facilities and competencies. With the ability to fundamentally and this in mind, we have acquired positively impact the healthcare Since inception, the Abraaj some pre-existing healthcare outcomes for millions of people. Group as a private investor has facilities (such as CARE, India’s 5th and middle income invested in over 27 healthcare largest hospital group) and will businesses across growth also make greenfield investments, markets. To support the wider providing growth stage capital to vision of system strengthening, healthcare companies, along with populations in global Abraaj established a healthcare a focus on strategic initiatives and Fund, which is dedicated operational improvements in these to establishing sustainable partner companies. growth markets: commercial investments in the healthcare sector in target cities Major centres of excellence of Sub-Saharan Africa and Asia. supporting our general hospitals The key intention of the Fund for these ecosystems will need The Abraaj approach and its partners is to serve the to include: mother and child, mass market, low income $3- the NCDs including diabetes, 15/d, (bottom of the pyramid) renal disease, cardiac and cancer Bobby Prasad by Bobby Prasad and middle income (middle of the care. We will also develop a Professor Bobby Prasad is Global pyramid) patient, fostering major mental health platform, a hugely Chief Medical Officer for Abraaj social development impact to neglected disease area in most and is based in the Group’s millions of patients in urban target markets. This allows us to identify London office. areas in South Asia and Sub- opportunities within clinical care He is a Gastroenterologist and Saharan Africa. delivery and embrace emerging Interventional Endoscopist by Today, there are significant clinical, demographic and economic changes occurring low cost technologies (including Creating access to affordable and training and has been in clinical in growth markets strongly influenced by a combination of changing lifestyles, rising point of care testing and wearable practice for over 20 years, having quality healthcare, strengthening non-communicable diseases and the continued fight against infectious diseases. Rapid devices). We also recognise that worked in senior roles in the UK of human resources and capacity standardised care generally leads and US including on faculty at urbanisation, rising incomes and an increase in the middle class have also prompted a building in a sustainable manner large component of these seismic shifts. However, clinical supply is not currently keeping to improved and measurable Yale University. He is a Council is the cornerstone of our strategy. results and our ecosystems will Member of the World Economic up with demand and healthcare is becoming increasingly expensive requiring large In addition, we believe that also provide a huge opportunity Forum’s Industry Agenda Council amounts of capital, substantial managerial and operational know-how, as well as a steady preventative healthcare needs for big data and hands on research on the Future of the Health pool of rapidly and well-trained clinical talent to resolve these issues head on – and this is to be emphasised much more in in affordable healthcare innovation Sector, a Fellow of the Royal even before catastrophic events like the Ebola Crisis are thrown into the equation. order to keep future healthcare and clinical outcomes. College of Physicians of London costs down. We need a system and the American College of where both clinicians and patients Clearly, there is no magic formula Physicians. Bobby is a graduate Without doubt, there is an absolute need for with the wider government health strategy, and are appropriately empowered. here but if we are to succeed then of the University of Oxford. a collective strengthening of the fragmented a focus on the needs of under-served population Achieving this requires a purpose- it requires implementing cost- healthcare systems that prevail today in our segments, will help to contribute to overall system built team of healthcare operators effective procurement and low markets. The frequently overstretched public capacity and quality. and experienced investors located cost diagnostics, using evidence health sector needs to be supported by all in their markets with strong local based therapy and technological Managing some of these major macro-type stakeholders including NGOs, as well private roots and deep connectivity. innovation supported by a global changes effectively and in a transformative way sector partners such as investment fund platform, strategic partnerships, will require huge infrastructural and financial managers like Abraaj and Big Pharma leveraging Our approach has been to build and economies of scale. investment crucially coupled with a massive their complementary strengths to meet these ‘fluid’ structures across outreach, investment in human capital. Only then will we challenges. Broader re-alignment of priorities primary, secondary and tertiary care to realise significant and measurable impact at reach. 126 127 Shaping our world
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Key areas which they felt more In response to these findings, support was needed included: Macmillan has developed a Preparing workplaces programme of support for One in two • Awareness raising of work and employers called Macmillan at people in the cancer issues generally e.g. how Work. There are two key elements to support staff affected it impacts on sickness absences to the programme: UK will develop • Dedicated support for line • Awar eness-raising to shift cancer at some managers with a particular employers’ understanding on focus on dealing with the what cancer means today, the point in their lives by cancer ‘emotional side’, ‘having difficult importance of being prepared conversations’ and ‘awareness and the support available from of the types of treatment and by Liz Egan Macmillan both for employers support’ and employees on returning to • Increased awareness of work after cancer signposting for employees living • Education for line managers, with and beyond cancer. HR and Occupational Health (OH) professionals to support One in two people in the Of the 2.5 million people living with the right way also has business Further research with small to employees affected by cancer. cancer in the UK, approximately benefits. Not only to fulfill legal medium size enterprises (SMEs) UK will develop cancer at This includes online and offline one in three is of a working age. obligations, but also in retaining identified the capability of an some point in their lives. resources as well as bespoke With improvements in survival knowledgeable staff, and saving SME employer to manage an Macmillan Cancer Support’s face to face training sessions and more people working longer on the costs of recruitment and employee dealing with cancer and consultancy. Specific online- report, Cancer: Then and retiring later, the numbers of training. It fosters loyalty, and was compromised by a lack of resources are available for SMEs. and Now, showed earlier people in the UK who will be in drives a positive company image experience due to the size of diagnosis and advances in work with cancer is predicted to to customers and potential the business. Lack of access to treatment have contributed increase to 1.7 million by 2030. In employees. informed and appropriate sources addition, an estimated 700,000 of support were also key barriers. to improvements in cancer A positive economic impact can cancer carers in the UK in 2016 survival rates. In fact, people also be observed. According to a are currently working. Whilst not recent report, people living with are now twice as likely to everyone will be able to or want cancer contribute about £6.9 survive for at least a decade to work after a cancer diagnosis, billion to the UK economy each after being diagnosed as a recent survey for Macmillan year through paid employment. they were at the start of showed 85% of people who were in the 1970s. But for many work when diagnosed with cancer Research carried out by Macmillan survivors, cancer leaves said it’s important to them to with large employers found nearly continue to work after diagnosis. a lifelong legacy of side- a fifth of line managers felt either These growing numbers highlight effects. quite or very uncomfortable the increasing importance of talking about cancer. Further employers being prepared to findings indicated a relatively support staff affected by cancer. weak understanding of cancer as an illness and its effects in the Evidence shows well-targeted workplace. 90% of line managers support in the workplace can help said they would benefit from prevent people falling out of work additional resources or support, due to ill-health. Remaining in such as online, offline and access work can have a positive impact on to more bespoke face to face wellbeing and can help preserve support. livelihoods. Supporting staff
128 129 The Global CMO network can play its part in raising awareness of the ongoing improvements in cancer survival rates and the business case for supporting cancer in the workplace
While Macmillan has seen some really positive engagement from employers, there are still some key challenges. Generally, employers tend to be reactive - seeking out support only once they already have an employee diagnosed with cancer. Employers need to take a more proactive approach to cancer at work, to ensure appropriate policies are in place and line managers have the skills and capacities to support people affected by cancer. Having appropriate support in place, would ensure that from the first conversation an employee affected by cancer feels supported and the line manager is able to offer the right information and guidance.
To enable a shift in understanding of what employers can do to support their staff, we propose the Global CMO network: The Macmillan at Work programme has seen yearly Other impacts from those accessing bespoke Liz Egan growth in demand for support from employers. training included: • Promotes the importance of including cancer and other Liz Egan is the Programme Lead for the Working through Since the 2011 launch of the flagship resource The long term conditions within employer health and wellbeing • Greater reassurance for HR professionals and Essential Work and Cancer toolkit, over 56,000 Cancer programme at Macmillan line managers on their approach to supporting strategies – to help them work towards being proactive in Cancer Support. Liz is a lawyer copies have been ordered. In 2014, the scaled up employees affected by cancer implementing support for employees living with cancer by background with over 20 offer including access to free resources (i.e. toolkit, years’ experience in the voluntary e-learning and newsletters) as well as paid for • Support to delivery of accurate and useful • Promotes the integral role of line managers and the sector. Since 2010, Liz has led the bespoke training, achieved over 3,800 employer information to staff importance of equipping line managers with the skills development and delivery of a sign-ups. To date, 1,860 line managers and HR and capacities to support employees affected by cancer Macmillan programme to support professionals have participated in training sessions. • Helped to identify gaps in organisational policies people affected by cancer in the • Encourages employers to review their work processes and UK to stay in and or return to A recent evaluation of Macmillan at Work found • Increased awareness of key issues involved in work. policies to ensure they are easily applicable to supporting that 79% of respondents who received support supporting staff affected by cancer employees affected by cancer and that they are implemented Liz is a member of a European- from the programme felt very well or well • HR and Occupational Health (OH) professionals consistently across their respective organisations. wide research network on Work equipped in terms of return to work planning working more closely together to ensure more and Cancer (CANWON) which for employees affected by cancer. 93% stated aims to sharing knowledge and appropriate and timely referrals to OH Macmillan at Work was important in achieving best practice on work and cancer. their levels of competency in relation to a range of • Support to creation of in-house champions to knowledge and skills on work and cancer. support roll-out of good practice.
130 131 Shaping our world Member of the Network
same ones at different facilities. Furthermore, it is difficult to compare Example payment on individual codes across providers, and even more difficult to Sustainable value and aggregate the various codes to determine a complete “package” price A health insurer forecasts for a defined procedure. one claim for a coronary artery by-pass graft Recently, criticism has been levelled at governmental and some procedure in the next quality for employee commercial healthcare reimbursement that rewards providers for the quarter for a population quantity of care they deliver rather than for the overall value of those of 1,000 people and the services. As a result, proposed regulatory and policy changes incentivise price of the procedure is health through a models of healthcare delivery and payment that focus on coordination of estimated to be $100,000 care and value-based purchasing. By paying for related care as part of a when it is performed. bundled package, the various service providers that treat the patient will be incentivised to better coordinate care, avoid unnecessary services, The insurer charges a healthcare services and improve patient outcomes and experience. Financially, associated premium of $100 to the savings are expected from reduced spending on provider services during policyholders to pay for the hospitalisation as well as post-acute care efficiencies. expected cost of $100,000. The health insurer makes an contracts exchange TBPCs are one amongst several emerging innovations designed to take offer to a provider to pay advantage of these different incentives. These contracts do not replace $100,000 for the procedure or compete with traditional insurance. The health exchange marketplace by Dr Eric Silfen when it is performed. aims to quantify and make transparent a commonly accepted price for a If the offer is accepted, procedure, group of procedures or a medical condition. For providers, it then both the insurer and means payers will become more reliable with payments. For self-insured provider are hedged against employers, understanding the market value of healthcare provides a future price increases or sound basis for understanding price risk. For insurance companies, decreases. The result is that understanding price risk provides a better opportunity to offer more fair The benefits for employees, employers, providers the actual price is the same In the United States and in many other and competitive rates to their clients. Finally, the price risk that exists and insurers in developing new budgeting as the budgeted price, and parts of the world, how employers between payers and providers is enormous. It can be measured as the innovations are substantial: both the insurer’s and the structure the payment to healthcare cost of claims. It is an economic peril with unpredictable outcomes, and provider’s earnings are providers for their employees’ health 1. Certainty of the price for healthcare services the subject of quantitative finance. Attempts to control this risk through more predictable. and wellbeing has been criticised for such that they could be bought and budgeted the cost of medical claims have failed due to the level of variation that rewarding providers for the quantity for in advance exists in price among providers. With TBPC’s™ bundled healthcare services, health insurers can manage price risk by hedging contracted of care they deliver rather than for the 2. Improving access to care as hospitals and services on a regulated, public exchange. overall value of those services. providers will always be in-network when they enter and participate in the healthcare contract The trading of TBPCs have the potential to play a role in creating a Tradable Bundled Payment Contracts™ (TBPCs™) market health futures market or Exchange. The three parties involved in this offer just one example amongst many emerging market are TBPCs payer, the provider and the intermediary or Exchange. innovations of how employers, insurers and 3. Reducing costs by shrinking the 20-30% of The trading process is simple. First, the payer makes an actuarial forecast providers can develop novel more efficient ways to healthcare spending on administration to 5% of the number of procedures needed by the covered population. Second, purchase healthcare, while hedging against price through exchange-based efficiencies the payer purchases a portfolio of health futures contracts in proportion risk. In essence, these are exchangeable medical to the medical costs forecast. Now, the payer is hedged, so when it takes 4. Improving quality for patients through care contracts with standardised terms and delivery of the contracts to offer services to its covered population, its measurable outcomes and standardisation conditions that specify comprehensive payment actual cost should equal its budgeted cost. Concurrently, providers sell of clinical practice as well as simplicity and for procedures, conditions or covered persons, the same portfolio of bundled healthcare services. Now, they too are reliability of delivery. for delivery within a particular time period, at an hedged so that when they deliver the contracted healthcare services, agreed upon location or geography, for an agreed Unfortunately some parts of the healthcare their revenue is as forecast. Finally, the rules, regulations and platform upon price and coupled to a set of risk-adjusted, industry have developed complex and opaque through which these trades take place define the Exchange. Through the patient-centric outcomes. ways for pricing definable services and procedures. Exchange, price transparency is fostered and maintained so that payers For instance, a single procedure like a cardiac and providers can openly negotiate in good faith. pacemaker implantation is comprised of numerous, individual payment codes and not necessarily the
132 133 Furthermore, the broader concept of an Exchange brings significant societal benefits. Since any provider that offers healthcare services is part of a network acceptable under any plan and to any insurer or payer, the concept of exclusionary networks is minimised. Prices would be transparent for all participants and system costs will fall. Furthermore, such a pricing approach can seed an Dr Eric Silfen individual health services market Eric Silfen is an international associated with high deductible, expert on the implementation health savings accounts of information technologies in (HSAs) and “medical tourism” the medical setting; hospital opportunities as well as foster and health plan clinical affairs; enhanced patient satisfaction disease and care management programmes; and clinical quality (experience) for complex, costly and performance improvement. surgical procedures and medical During his time as Chief Medical conditions. Since the ultimate Officer for Philips Healthcare, beneficiary of better pricing and Eric led the Office of Medical payment reform must be a patient, and Health Affairs and worked higher quality and consistent to inform and communicate patient experience must be at the Philips Healthcare thought core of this proposition. leadership around the world. Operationally, he was responsible Finally, once payers, providers, for embedding a “medical insurers, patient representatives consciousness” in Philips Healthcare by developing the and those interested in reforming clinical and econometric evidence the healthcare financing system that helped differentiate the take the lead on defining and company’s products, services extending the terms for such and solutions in the global an Exchange as well as the marketplace. necessary infrastructure, it might be reasonable to claim that the puzzle of the elusive “triple aim” of improving the patient’s experience of care, improving the health of populations, and reducing per capita costs of healthcare has been solved.
For information regarding Tradable Bundled Payment Contracts™ contact U.S. Health Futures, LLC at www.ushealthfutures.com.
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Member of the Network Vitality: Improving health for its workforce, for the workplace and the community
by Dr Derek Yach and Dr Cother Hajat health and wellbeing decisions are commonly left Similar programmes exist in all Vitality markets to chief medical officers and human resources and insights from Vitality in the US confirm officers to manage as unavoidable costs, and are that company employees had improved healthy rarely considered by CEOs and CFOs as areas for behaviours by quitting smoking, increasing their investment. fruit and vegetable intake, and spending less Common concerns Vitality provides corporate lifestyle were hospitalised, the total number sedentary time in front of a screen compared with In 2014, The Vitality Institute Commission on and health promotion programmes of days hospitalised, number of the average US population. regarding workplace-based Health Promotion and Prevention of Chronic in line with its core purpose of admissions, length of stay and interventions include the Disease in Working-age Americans made several Improving health for the wider community making people healthier. Studies cost per hospitalisation were lack of perceived benefit and recommendations to improve policies for health from its corporate insurance significantly lower in the highly Vitality’s reach in the community is extended in the United States including the integration of impact to employees’ health, customers show improvements engaged group compared with through numerous external collaborations, health and wellbeing into corporate reporting. and that by instituting in healthy behaviour and health other members. partnerships and networks. Vitality partnered on “Reporting on Health: A programmes designed to outcomes in members engaged Furthermore, economic modelling Roadmap for Investors, Companies, and Reporting Vitality Health, Mercer, the University of Cambridge alter employees’ behaviour, with the Vitality programme. For studies suggest that companies Platforms” to address corporate reporting and the and RAND Europe collaborated towards Britain’s example, the healthy food benefit employers may be crossing recognised for successfully role of companies in improving the health of their Healthiest Workplace (BHW), a survey of more that offers a 25% rebate on the the line on privacy issues. creating a workplace culture of employees and their potential impact on consumer than 32,538 workers across all UK industries. The purchase of healthy foods was health and safety are more likely health. The vision set out for this work was that by study revealed that high stress and lack of physical Yet convincing evidence shown to result in a 9.5% increase to outperform the market on 2020, workforce health metrics will be an integral activity are causing industries to lose up to 27 exists through systematic in healthy food purchases in stock market performance. A 2013 indicator of the organisation’s performance within days of productive time per employee each year. reviews of workplace- South African Discovery Vitality study by Fabius et al. tracked the broader corporate accountability framework While poor diet, alcohol and cigarettes have severe based interventions of their members. In another study, performance on the SandP 500 which will be shared with shareholders and effects on long-term health, it is stress and physical Vitality members who were highly effectiveness in addressing for a group of health and safety investors. activity which have the greatest impacts on day- engaged with healthy behaviours various risk factors for award winners using a theoretical to-day productivity. Other findings were that such as physical activity had Improving health for the vitality workforce NCDs, as well as improving investment between 1999 and productivity varies enormously between industries, approximately 35% fewer hospital 2012 based on four investment A healthy workforce has been shown to be more with some industries losing almost 27 days of worker productivity. admissions associated with cancer portfolios. Results indicated these productive and profitable in terms of operational productive time per employee per year, compared and mental illness, and 20% fewer companies outperformed the efficiency, employee recruitment, and retention. to a national average of 23.5 days. The financial hospital admissions associated average SandP 500 by between Vitality’s own workforce health promotion implications of this productivity loss are huge, with with endocrine, nutritional, and 3-5% annually, with similar programme, Discovery’s HealthyCompany provides the UK losing £57 billion a year on average metabolic disorders as well as outcomes reported in South regular screening and wellness initiatives for in lost productivity. kidney and urinary tract disorders. Africa. Despite such findings, its employees such as company wellness days, For those Vitality members who HealthyFood and Vitality gym benefits, and health campaigns such as the 10 Tonne Challenge, with positive impact seen in health measures such as healthy food spend and average daily steps. 136 137 Shaping our world
Vitality UK has numerous health and wellbeing Recognition, innovation and the future Conclusion partners and recently partnered with Apple, Vitality was selected for Fortune’s inaugural allowing Vitality members to purchase an Apple “Change the World” list – 51 companies “that Investment in workplace health has clear benefits for employers, employees, and the communities Watch for a discounted price of £69 if they have made a sizable impact on major global in which they live. There is sufficient evidence for what constitutes an effective workplace health maintain exercise goals of at least 10,000 steps social or environmental problems as part of their programme. There is now growing recognition of the role of workplace health leading to the current every day, or undertake more vigorous exercise on competitive strategy.” The Vitality Group in the global movement of several networks of public and private partners with whom Vitality is proud to 20 days a month over a 24-month period, following United States was also awarded by the Global serve as a key industry collaborator. the success of this model in South Africa. This Centre for Healthy Workplaces for ‘living the brand’ relationship ensures that Vitality is optimising from and offering many health-promoting initiatives the latest technology and Apple is finding a health- to its own employees including innovative office promoting niche for their device. design, corporate-sponsored health events for employees and their families, employee-friendly Ensuring that Vitality’s work is based on and working hours, access to Vitality’s workplace health actively contributing to the evidence-base behind programme for all employees and discounts on healthy lifestyles is vital to the ethos of Vitality health insurance. and academic partnerships is crucial to ensuring that this aim is met. Currently, academic partners The use of technology is at the core of the work include the Universities of Cape Town, Cambridge, of Vitality. With that in mind, Vitality published a Oxford, Pennsylvania and the Rand Corporation. viewpoint in the Journal of Health Communication to launch a public consultation on Responsibility Increasingly networks are being established to Guidelines for Personalised Health Technology achieve system level change, set standards and lay that includes the building and scaling of affordable out the future vision for workplace health. Vitality’s health technologies, interpretation of health data, Dr Derek Yach, MBCh Dr Cother Hajat, MBBS, MPH, PhD, FFPH leadership is actively involved in several high-level and securing and governing the responsible use of networks including the Business and Industry Derek Yach has focused his career on advancing Dr Hajat is a public health physician and health data. Advisory Committee (BIAC) to the OECD, Private global health. He is currently the Global Chief epidemiologist Her expertise is in establishing Health Officer for Vitality. prevention programmes for chronic disease and Public Partnership Roundtable for the Global Vitality recognises the need to tailor lifestyle research into the impact of lifestyles interventions Health, the Global Alliance Roundtable, the United interventions for workplaces and for their Previously, he was SVP of Global Health and on cardiovascular and chronic disease. Notable Nations Global Compact Leaders’ Summit, and workforce in order to successfully lead to Agriculture Policy at PepsiCo; Executive Director work includes work in the GCC as Medical the Bupa CMO Network. behaviour change. Examples of Vitality’s work to of Non-communicable Diseases at WHO; and Director for Truven Health Analytics, establishing tailor interventions include a seniors’ programme Professor of Global Health at Yale. Dr Yach the Weqaya and Breast Cancer prevention serves on several advisory boards including Employees’ HealthyFood spend as for the over 70s with US clients and women’s programmes in Abu Dhabi and her work on the those of the Wellcome Trust, Cornerstone a percentage of total food spend at workplace health, including a comprehensive King’s College London Stroke Registry. Capital and the World Economic Forum. He pregnancy package for South African members. partner stores has authored or co-authored over 250 articles Dr Hajat’s work is internationally published in covering the breadth of global health, regularly the Economist, peer-reviewed journal articles, 29.4% 30.2% 30.1% 31.1% publishes blog posts, and is cited by the books, newspaper editorials and blogs and Employees taking steps to increase their Huffington Post, The New York Times and The she is a regular keynote and invited speaker at levels of physical activity Economist. His degrees include: MBChB from International Conferences and Meetings. She 2014 2015 the University of Cape Town; BSc (Hons Epi) – holds a MPH with distinction, MBBS and PhD University of Stellenbosch; MPH – Johns Hopkins from King’s College, London and is a Fellow of 3,639 Bloomberg School of Public Health; a DSc the Faculty of Public Health (UK). (Honoris Causa), Georgetown University. Q2 Q3 Q4 Q1 3,375 2014 2014 2014 2015
2,617 2,529
Vitality gym Other fitness benefit active events tracked 138 139 Shaping our world Friend of the Network
aggregate data to avoid crossing not only employees dealing with If investment decisions are not the privacy line when focusing on their own recovery and illness, informed by people’s needs and Commentary: employee behaviour. On the basis but also as carers for children, informed preferences, the system of this indicative evidence and the parents, and others. Workforce will fall short of meeting basic superior business performance of productivity gains would be just upstream needs while exceeding Shaping the future: companies that have been cited for the beginning of the return on what they want by delivering their health and wellbeing culture, investment in such programmes. harmful and wasteful downstream Vitality makes a strong case for Much of the waste and harm in rescue care in the acute setting. reports of employee health and healthcare today stems from This concern about the information What kind of healthcare wellbeing at the aggregate level as substitution of expensive and needs for building system capacity, an integral indicator of corporate dangerous acute care services or for commissioning services for performance. It presents a vision of for simpler safer social services a defined population, extends to the future that includes a new set because we have failed to move up economy do we want to the highly innovative proposal for a of workforce health metrics that stream and address the emotional health services contract exchange. will be core to existing corporate and social context in which people The most proximal objective of social responsibility and critical for experience illness themselves and the proposed exchange is to leave for our children? consideration by all shareholders, when it affects loved ones. The hedge against price risk with and potential investors. workplace is a pivotal part of that exchangeable contracts with context. by Al Mulley While the Vitality case focuses standardised terms including on prevention, the MacMillan The Abraaj case offers an specification of bundled payments at Work case is about making ambitious vision of shaping the for procedures, and conditions or the workplace a supportive future by investing in physical covered persons. Important goals community for those recovering and human resources to create include price transparency and from and living with cancer. integrated systems of care across reduced administrative costs. Governments have undertaken In addition to this, it is here that With improvement in cancer ‘Growth Markets’ with an early Since the economic However, there are potential major healthcare reform efforts in health partnerships with schools, survival rates and one of three focus on urban areas in Sub- downturn of 2008, unintended consequences of both market-driven and tax-funded employers and the voluntary people living with cancer of Saharan Africa and South Asia. The governments and employers health futures contracting. Many healthcare economies such as sector can contribute most to working age, 85% of people vision includes a ‘fluid structure’ across the globe have seen of the procedures that would those in United States and United health and wellbeing across the in work when diagnosed with across primary, secondary and be subject to the exchange, the need to create a future Kingdom, respectively. Common life course. Given that employees cancer want to continue to work. tertiary care with a hub and spoke including those cited as examples for healthcare delivery that elements of reform include efforts in their most productive years Yet misperceptions and poor model. Vertical service lines will in the case, are delivered at is far different from the to better integrate care across are often the principal sources of knowledge about cancer leave include maternal and child health highly variable rates to seemingly three dimensions: primary and support for children and parents nearly 20% of company line and non-communicable diseases, reality of today. Demand similar populations in different acute care, care for mental and with health and social care needs, managers uncomfortable talking but also the often neglected for healthcare services geographic areas. Easily avoidable physical health, and care for social it would be difficult to overstate about cancer and the attendant mental health needs. Clinician and their costs continue to ignorance has been documented and health needs. And within the opportunity for employers emotional issues. The MacMillan competencies will be supported repeatedly, on the part of patients rise even as fundamental each of these three integrations, to shape the future of health for at Work programme uses The by ongoing education and about the benefits and harms of shortcomings are revealed there is a recognised need to today’s and future generations. Essential Work and Cancer Toolkit protocolised decision making. The an intervention, and on the part by wide variations in access, better balance investment by The four case studies suggest a to address such knowledge and service lines emphasised by Abraaj, of clinicians about what patients shifting resources to build greater number of ways forward. competency gaps and position especially mental health, suggest quality, and efficiency of actually want when they are capacity ‘upstream’ – from acute managers and executives to take that they will be careful to make care. Estimates suggest that Vitality describes a concerted engaged and understand the to primary care, from physical to a more proactive approach to balanced investments across the 20-40% of all that is spent effort to improve the health trade-offs. mental health, and from health making the work environment three dimensions of integration. on healthcare globally is of its workforce and, through to social needs. It is here that the a place of support. Such an Research across the globe has strategic partnerships, that of the wasted, while more than opportunities for prevention are approach could be generalised to shown that whatever capacity is community. It provides indicative 1 billion people worldwide greater. other conditions, and to support built will be used. do not get the care they evidence for impact in areas where it has been historically difficult need. to demonstrate benefit, using
140 141 Research has shown that when that ignorance is avoided, utilisation rates often fall substantially even in regions with relatively low rates. This raises important questions about the actuarial forecast of procedures to be purchased for a defined population, and about the potential for health future contracting to support and sustain over-utilisation. Albert Mulley, MD, MPP A critical component of shaping the future of healthcare will require Albert Mulley is Professor of Medicine and of Health Policy a repurposing of primary care to and Clinical Practice and engage and support patients in Managing Director of Global understanding their preferences Healthcare Delivery Science to avoid uninformed treatment at the Dartmouth Institute decisions at the frontlines and for Health Policy and Clinical uninformed capacity investment Practice. and funding decisions at the system level. Prior to his current role at Dartmouth, Al served at Harvard and Massachusetts General Hospital where he was founding Chief of General Medicine with responsibility for research, education and training, and design and implementation of new care models. His research has focused on practice variation, the quality of medical decision making, and implications for the funding and efficiency of healthcare services. He has published more than 100 research articles and commentaries as well as Primary Care Medicine, the earliest textbook of its kind.
He was an originator of “shared decision making” and other approaches to co-production of value in healthcare and, together with colleagues, developed and brought to scale measures and tools to support their implementation.
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