Engaging Key Stakeholders in Health Improvement Programs
June 13, 2006
HR and benefits teams considering a health improvement program have to define success for two separate audiences – the company’s employees and the folks in the CFO office who control HR’s budget. At first glance, effectively engaging employees while satisfying a numbers-driven financial team may seem like incompatible goals. After all, company cost savings aren’t exactly a motivating call to behavior change for employees. And when budgets get tight, dollars invested in a health improvement program start to look a lot like low-hanging cost-saving fruit to many CFOs.
Upon closer examination, emerging studies demonstrate that a well designed and implemented health improvement program can and should satisfy these often disparate stakeholder groups – creating a truly “win-win” initiative.
Acknowledging the experts
A key to successful health improvement programs is behavior change – somehow moving employees toward choices that will improve their health. The most widely accepted perspective on changing behaviors is the Stages of Change Model (SCM). Developed in the 1970s by Drs. James Prochaska and Carlo DiClemente, the SCM revolutionized thinking in the medical, psychological and, later, business communities about how people change behaviors.
Even though the SCM’s widespread application to successful behavior change programs around the world makes it hard to refute as a framework for health improvement programs, in some organizations, nothing shuts down a dialog faster than introducing an academic model. But the wisdom of the SCM and its potential value cannot be overstated. Its power was in casting change as a process, not an event, comprising six distinct stages:
· Precontemplation – not yet acknowledging a problem that needs to be changed
· Contemplation – acknowledging a problem but not ready or sure of wanting to change
· Preparation/Determination – some experience with change, getting ready to change
· Action/Willpower – practicing the new behaviors
· Maintenance – sticking with the new behaviors
· Relapse – resuming old behaviors
The process isn’t always linear; people will sometimes move back and forth between stages. Though this may seem discouraging, it’s also reassuring that a slip-up or relapse isn’t the end, but another stage, one that requires some guidance and reassessment to get back on track.
The fundamental message from SCM to organizations looking to engage employee to undertake lasting lifestyle changes is that the program must be designed as a process that is sustainable over time. When applied to the often diverse needs of employees and CFOs, the SCM goes further and provides some fundamental guidelines for decision-making and program design.
An effective appeal for change
Regardless of the model providing the theoretical underpinning, changing employee behavior is hard. It’s so hard, well, it’s almost as hard as getting some CFOs to change their minds about the value of investing in health improvement programs. In fact, CFOs may actually be farther along the change continuum identified by the SCM than many employees. According to a 2006 Duke University/CFO Magazine survey, rising health care costs is identified by CFOs as the number two risk factor (behind global competition) for corporate America – which puts them well into the SCM “contemplation” stage since most at least know there is a problem.
Many employees, on the other hand, don’t even know their lifestyles are creating a problem. While most understand the growing concern around health care costs, far fewer are prepared to recognize their potential role in bringing down the cost curve. Some experts have said that even when faced with extreme, life-threatening illnesses, fewer than 10% of people will change their lifestyles to improve their health.
Many experts now believe that people need a passionate, often emotional appeal along with facts and figures to catalyze the first steps toward change. In other words, for many people, a looming threat of what could go wrong won’t provide the impetus – but a clear vision of what could “go right,” and how you can get there might.
Applying this thinking to both key stakeholder groups, a critical program design component is to be clear on the benefits of improved health. CFOs may want to see this vision in terms of year-over-year savings, but try to find a way to translate these numbers into something that resonates – such as the opportunity for investing those saved dollars in other company initiatives. As for employees, losing weight to side-step a heart attack or diabetes may have less appeal than benefits like being able to perform their job more easily or just enjoy life with less pain or discomfort.
The point is, make sure to provide a variety of materials and information that emphasize not just the "how-tos" of changing behavior – though those are important – but the “what ifs,” encouraging both stakeholder groups to imagine positive possibilities.
When picking messengers, aim high for action and sustainability
Most ambitious corporate initiatives, such as an acquisition or new product launch, would be unthinkable without leadership support. After all, it is the job of company leadership to provide vision and direction. Although historically health care has been seen as the purview of HR and benefits, the dollar investment in health care alone has made it of interest (and often concern) to most senior leaders. A growing number of CEOs are coming to understand the full scope of the problem, as the indirect costs of poor health (absenteeism, disability, presenteeism) can be two to three times higher than direct medical costs. Senior leadership at organizations as diverse as Dow Chemicals, The Home Depot, Navistar and the State of Ohio has already taken on roles in advancing and supporting health promotion in the workplace, and making it part of their overall business strategy.
Employees expect leadership to provide a broad outlook and to inspire success. There is no substitute for a well-respected senior leader that “walks the talk” – and health improvement is no exception. Engaged senior leaders can also be critical to motivating the CFO and her team to continue program investments.
Target messages and measure progress
Health risk assessments (HRA) are fundamental to nearly all health improvement programs, and for good reason. The individual results they produce point employees in a more specific direction toward health improvement. They also pave the way for a communication strategy built largely upon targeted messages to individuals based on the risks and lifestyle issues identified in the HRA – a much more personal and effective means of communicating than mass wellness messages.
HRA results, along with existing claims and other data, can also be part of a baseline program measurement. Health improvement programs can and should be measured. On the one hand, CFOs are sure to be interested in findings that run parallel to those by the National Business Group on Health. Assessing more than 120 studies on the effectiveness of employer-sponsored health promotion studies, they cite benefit-to-cost ratios of $3.48 in reduced health care costs, and $5.82 in lower absentee costs per program dollar invested, and ROIs of at least $3 to $8 per dollar invested within five years of program implementation.
In addition, careful measurement and tracking of results provide important opportunities to refine the program and sharpen its focus. For example, better information might lead to more aggressive programs targeting specific prevalent high risk conditions or troublesome company locations.
Measurement and results should not be limited to numbers. Whenever possible, sharing personal success stories from employees helps bolster the positive messages and sustain or spark interest in the health improvement program.
Provide ongoing support
Support that comes in the form of health coaches or support groups significantly helps employees along the change continuum, sustains change and refocuses them at points of relapse. Extending support services shouldn’t necessarily be seen as upping the program investment – either in terms of dollars or time spent away from the job.
Health coaching, for example, is a burgeoning service offered by many plan providers and health improvement companies. These one-on-one relationships for employees not only provide ongoing encouragement, but can focus employees on the behavior modification likely to yield the greatest impact.
Peer-to-peer support, also demonstrated as valuable in sustaining change, now takes many forms. Companies can provide on-site space for traditional venues, such as after-hours or lunch break Weight Watchers or smoking cessation group meetings. But the interest and literature supporting the effectiveness of online or virtual support groups is growing. The American Lung Association, for example, offers an online smoking cessation program which includes both incremental information received via email and access to a support group community of others in the process of trying to give up cigarettes. Some health improvement companies include web communities as part of their offering, where participants can join in health-related chats or bulletin boards. As cell phones and PDAs become increasingly sophisticated, expect to see more support services pushed out to individuals via handheld devices.
The financial (or CFO) appeal of support services is that they hasten and sustain behavior changes, thereby delivering potentially greater and quicker financial results – and often at little or no additional cost. Many health improvement companies and plan providers include coaches as part of their overall service offering (generally for higher-risk employees or those with chronic medical conditions). Even more offer web-based tools for employees, though these vary in sophistication.
The health improvement and wellness market is exploding with service offerings. Though many are compelling, it’s unlikely that even the most sophisticated single product can bring about the sustained behavior changes sought to improve employee health and an organization’s financial fitness. Organizations need to carefully consider an array of options in light of what’s proven about the process of changing behaviors, and what’s required to satisfy the needs of the two primary stakeholder groups, employees and stakeholders. That will keep both groups engaged for the longer term and markedly improve the outcomes overall.
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