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Work Engagement and Occupational Stress in Healthcare Workers

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Work Engagement and Occupational Stress in Healthcare Workers

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Work engagement and occupational stress in nurses and other healthcare workers: the role of organisational and personal factor

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Brief Mindfulness Practices for Healthcare Providers

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Brief Mindfulness Practices for Healthcare Providers

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Brief Mindfulness Practices for Healthcare Providers – A Systematic Literature Review

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The Effects of Perceived Stress in Healthcare Professionals

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The Effects of Perceived Stress in Healthcare Professionals

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The effects of perceived stress on biological parameters in healthcare professionals- A systematic review

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See appendix B for tool.

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Creating a Recipe for Employee Engagement

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Creating a Recipe for Employee Engagement

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Employee Engagement Pie

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Stress Reduction

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  Original article Stress management interventions in the workplace improve stress reactivity- a randomised controlled trial

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Effective and Viable Mind-Body Stress Reduction in the Workplace- A Randomized Controlled Trial

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Preventing occupational stress in healthcare workers

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Web-based interventions for the management of stress in the workplace- Focus, form, and efficacy

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Workplace Stress

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Workplace Stress - The American Institute of Stress

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Workplace Stress Are you experiencing workplace stress?
The Free AIS Workplace Stress Scale (WSS) was developed in 1978 and modified in 2022
to serve as a preliminary screening measure

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Fact Sheets, Books, and Tools

Healthy Work Campaign Tools for employers, union organizers and working individuals to create and sustain a healthy workplace

CPH-News & Views
Written by CPH-NEW investigators, CPH-News & Views is a semi-monthly column on emerging topics related to healthy workplaces.

Fact Sheet- Introduction to Job Stress (pdf)
Developed by CPH-NEW, this fact sheet gives an overview of job stress including: Prevalence of job stress, signs and symptoms of job stress, health effects of job stress, suggestions for designing healthier jobs, examples of workplace stressors, and more.

Fact Sheet- Business Case for Addressing Job Stress (pdf)
Developed by CPH-NEW, this fact sheet outlines the financial costs of job stress resulting from various aspects of workplace stress including:Turnover, health insurance, absenteeism, depressive illness, and more.

Job Stress Intervention Guide (pdf) Developed by CPH-NEW, the purpose of this intervention guide is to assist workplace health and safety practitioners use a participatory approach to design, implement, and evaluate comprehensive stress prevention and control strategies for the workplace. The information contained in this guide coordinates with CPH-NEW Intervention, Analysis and Design Scorecard (IDEAS) tool, available as part of the Healthy Workplace Participatory Program toolkit.

NIOSH- Stress At Work Booklet (pdf)
This booklet provides information pertaining to what job stress is, causes of job stress, job conditions that may lead to stress, job stress and health, warning signs, stress and productivity, prevention, and examples of what some organizations have done to reduce job stress.

This informational blog post provides insights into compassion fatigue, secondary trauma, moral distress, and burnout in the healthcare workers. The blog also discusses how to recognize determinants of workplace stress and how to form healthy habits for self-care and improvement. Additionally, the resource provides strategies to overcome barriers raised by workplace stress.

APA: Mind/Body Health
This interactive tool shows how stress affects your body's physical health.

HelpGuide: Stress at Work: How to Reduce and Manage Job and Workplace Stress
Informational webpage that describes coping with work stress in today's uncertain climate, warning signs of excessive stress at work, ways to reduce job stress, and what managers or employers can do to reduce stress at work.

HelpGuide: Stress Management: How to Reduce, Prevent and Cope with Stress
This informational webpage describes ways that individuals can reduce, prevents, and cope with stress. Topics include: Identify the sources of stress in your life and look at how you currently cope with stress. Additionally, the site provides various stress management strategies.

Sloan Work and Family Research Network
This website provides various fact sheets that address topics such as: flexible work schedules, low wage workers, health and workplace flexibility, older workers, overwork, part-time work, shift work, and more.

Unhealthy Work: Causes, Consequences, and Cures
Schnall, P.L., Dobson, M., Rosskam, E.(2009). Baywood Publishing Inc., Amityville, NY.
This is an interdisciplinary book that examines the changing nature of work, new evidence linking work conditions with ill-health, and unhealthy work as a public health problem.

Wellness Council of America
This website provides resources for improving worksite wellness and is dedicated to helping organizations build and sustain results-oriented wellness programs. Some of their resources include: reports, interviews, case studies, presentations, surveys, and more.

Healthy Work: Stress, productivity and the reconstruction of working life. (1992). Karasek, R., Theorell, T.Basic Books, Inc. New York, NY.
This book analyzes various stress/work studies done in America and Europe.The authors discuss various ways to deal with the lack of worker participation in decision-making on the job. The authors conclude that the well-being of employees can and must be enhanced through meaningful involvement in formulating the manner and mode of their tasks.

Working on Empty is a transmedia and film project intended to address the "silent epidemic" of work-related illness and death in America. This website highlights facts about work stress and death and emphasizes the need to change the work culture in America to prevent unhealthy work stressors.

Surveys

Copenhagen Psychosocial Questionnaire (COPSOQ) - A psychosocial risk assessment tool designed for use in businesses to assess the need for action and to help the decision making process on preventive measures at the workplace level. The questionnaire was developed in 2000, and is available in 25 languages.

Stress Assess survey questionnaire (Occupational Health Clinics for Ontario Workers) - This survey is based on COPSOQ and is customized to address concerns within the Canadian workplace. This survey is available in "personal edition" for individual workers and "workplace edition" for people who want to administer the survey with employees in their organization.

The Job Content Questionnaire - The JCQ is an instrument created by Karasek, R., et al. for internationally comparative assessments of psychosocial job characteristics.

Karasek, R., Brisson, C., Kawakami, N., Houtman I., Bongers, P., Amick, B. (1998). The job content questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics. Journal of Occupational Health Psychology, 3(4), 322-355 (PubMed).

NIOSH Quality of Worklife Questionnaire
This 76-item questionnaire is available in the public domain; questions deal with a wide assortment of work organization issues, such as hours of work, workload, worker autonomy, layoffs and job security, job satisfaction/stress, and worker well-being. Normative data are available by industry using personal interview data collected in the Fall/Winter of 2002; the final dataset contains responses from 2,765 persons. Download the PDF version of the survey from theNIOSH website.

Landsbergis, P.A., Schnall, P.L., Pickering, T.G., &Schwartz, J.E.(2002). Validity and reliability of a work history of a work history questionnaire derived from the Job Content Questionnaire. Journal of Occupational and Environmental Medicine, 44(11), 1037-1047 (PubMed).

Siegrist, J., Starke, D., Chandola, T., Godin, I., Marmot, M., Niedhammer, I., et al. (2004).The measurement of effort-reward imbalance at work: European comparisons.Social Science & Medicine, 58(8), 1483-1499. (PubMed)

NIOSH Quality of Worklife Questionnaire. This 76-item questionnaire targets a variety of work-life topics such as hours of work, workload, worker autonomy, layoffs/job security, job satisfaction, stress, and worker well being.

Working on Wellness Toolkit (pdf).Massachusetts Department of Public Health. This toolkit provides employers with ways to promote and protect the health and well-being of the organization. It contains a sample work site health improvement survey that focuses on company policies and programs, including those addressing stress.

Belkic, K. (2003).The occupational stress index: An approach derived from cognitive ergonomics and brain research for clinical practice. Cambridge International Science Publishing.

American Institute of Job Stress: Job Stress Questionnaire
How much job stress do you have? Use this Likert scale questionnaire to assess how much stress you have.

APA: Stress Smarts Quiz
Quick, six question quiz about health and stress. After each answer is revealed, there is short synopsis of how the body is affected by stress.

Presentation Materials

Beyond Breathing: Organizational Approaches to Reduce Job Stress (pdf)
Nicole Champagne, Suzanne Nobrega, University of Massachusetts Lowell. Workshop given to the Ounce of Prevention Conference, October 21, 2008.

Work Organization, Stress, the Changing Nature of Work, and Cardiovascular Disease: Part I; Part II
Paul Landsbergis, PhD, MPH, Department of Community and Preventive Medicine, Mt Sinai School of Medicine, New York, NY. Presentation given to the Partnership for a Heart Healthy, Stroke-Free MA annual meeting, June 2, 2006.

Work Stressors: Causes, Consequences, and Cures (pdf)
Peter L. Schnall, MD, MPH, Professor of Medicine, University of CA Irvine and Director of the Center for Social Epidemiology. Presentation given to the Partnership for a Heart Healthy, Stroke-Free MA annual education conference, January 30, 2009.

Videos

Working With Stress
This is a NIOSH training and educational video program on the topic of workplace stress. It, "describes workplace factors that can create or exacerbate worker stress, and suggests practical measures for reducing job-related stress through changes in work organization" (17 minutes).

Stress: Portrait of a Killer
In this video, Stanford neurobiologist and author Robert Sapolsky compares the stress response of humans to animals of Africa. It reveals how dangerous prolonged exposure to stress can be, while explaining that "today, we turn on the same life-saving physical reaction to cope with intense, ongoing stressors - and we can't seem to turn it off" (5 minutes).

Organizations Focused on Job Stress

These websites are excellent sources for tools and guidelines that help employers implement workplace changes to reduce stress:

Reports

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Healthy Work Campaign Tools for employers, union organizers and working individuals to create and sustain a healthy workplace CPH-News & Views Written by CPH-NEW investigators, CPH-News & Views is a semi-monthly column on emerging topics related to healthy workplaces.

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Guidance on hazards and control measures to consider when undertaking a stress risk assessment

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As companies increasingly face rising health costs and competition, comprehensive workplace health programs are becoming more widely used as a strategy for impacting employee health and productivity and, in turn, corporate bottom lines.

Comprehensive workplace health programs aim to reach employees through a variety of ways, including workplace policies, benefits, environmental changes, and programs and services available for employees, spouses, and dependents.

However, each company and its employees is unique and the strategies used to address employee health will vary from company to company based on the resources available, needs and interests of management and employees, and health issues that are priorities.

A key question for wellness coordinators to ask is: How do you know which workplace health strategies will be most valuable for your particular company to implement?

Developing a comprehensive employee workplace health program, or making improvements to an existing one, requires an understanding of what impacts the health of employees at the worksite.

What is workplace health assessment

A workplace health assessment is a process of gathering information about the factors that support and/or hinder the health of employees at a particular workplace and identifying potential opportunities to improve or address them

A workplace health assessment helps to identify the current picture of health at a company as well as ways to improve it that can potentially increase productivity, decrease absenteeism, and control health care costs for both employees and the organization as a whole

It is a necessary first step before goals are developed, resources allocated, strategies adopted and interventions implemented, employees participate, and outcomes are measured

Factors influencing workplace health1, 2

Many factors influence health in the workplace and can be impacted by supportive changes within the following levels of influence:

Individual - elements of an employee's health, such as their health behaviors, health risk factors such as high blood pressure, and current health status

Interpersonal - elements of an employee's social network including relationships with managers, coworkers, and family that provide support; mentoring or role models

Organizational - elements of the workplace structure, culture, practices and policies such as benefits, health promotion programs, work organization, and leadership and management support for workplace health and safety initiatives

Environmental - elements of the physical workplace such as facilities and settings where employees work as well as access and opportunities for health promotion provided by the surrounding community where employees live

How to conduct workplace health assessment

A workplace health assessment involves learning about a workplace and the health of its employees. Employee health is determined by a complex set of interactions between the individual and their social, cultural, and physical environments and can be influenced in many ways. It is important to assess employee health from a number of perspectives using multiple sources of data to gain a more complete picture of the determinants of health. For example, reviewing health care costs will provide information on which health conditions are the biggest contributors to the total, but do not provide insight into what factors contribute to those conditions.

The types of data sources that will be available will depend on the workplace. Some data is readily available, other data may need to be requested from a third party, and some may not be currently available requiring a decision whether to collect it or not. The types of data sources used to gather information in a workplace health assessment may include:

Site visits
Site visits are in person observations of the workplace setting and includes interviews with managers and employees to discuss health attitudes and beliefs; and review health promotion programs and policies; and evaluate the worksite environment for health risks

Employee surveys
Examples ofemployee surveys include Health Risk Appraisals; employee satisfaction and interest surveys; safety surveys and routine inspections

Health benefits
The type ofcoverage and covered services employee receive under the health plan; vacation and sick time; access to health promotion programs

Health care and pharmaceutical claims
A source for identifying the common health conditions and procedures for which employees are seekinghealth care and their costs

Other data sources
Examples includetime and attendance; injury; and participation in, satisfaction with, or outcomes from other employee health programs

Other data sources may also provide information that will be useful for designing and evaluating a workplace health program. Such data sources include data on injury prevalence, causes and workers compensation; absenteeism; use of existing health programs such as EAP or fitness facilities. A possible list of data sources is provided in table below.

Other Additional Sources of Data Relevant to Worksite Health

Number of injuries, percentage of employees with injuries, cost of injuries, days lost by types of injuries, time to return to work

By worksite
By unit

Site Database
OHSA template

Use of EAP

Number of employees and number of sessions and cost by presenting problem

By worksite By unit

EAP Vendor Activity Summary

Job Satisfaction

Ratings of Job Satisfaction, Communication, and Support

By worksite By unit

Employee Engagement Survey

Tools and Resources

Key questions

Overall, a workplace health assessment can help make connections between the various types of risk factors affecting employee health at the individual, intrapersonal, organizational, and environmental levels that are supported through multiple pieces of data. It will help develop a deeper profile of what is going on at a workplace to help inform a workplace health improvement plan for initiating a workplace health program or making enhancements to an existing program. The key questions a workplace health assessment can help answer are:

What are the key health issues affecting employees?

What factors at the worksite influence employee health?

What are the employees' health and safety concerns?

What strategies are most appropriate to address these health issues?

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Work@Health® is an employer-based training program. The ultimate aim of the program is to improve the organizational health of participating employers and certified trainers, with an emphasis on strategies to reduce chronic disease and injury risk to employees and an eye to improving overall worker productivity.

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Mountains of Evidence Show the Benefits of Workplace Health Promotion Programs

Think of the different benefits employers typically offer. These could include a retirement or pension plan, healthcare, paid time off, or maternity leave. These are designed to help your organization recruit and maintain qualified employees. Yet there is not a single published study that shows that offering these benefits has any measurable effect on a worksite's ability to recruit or maintain workers. We do them because we believe they are important.

These things are actually very hard to study and we have a feeling or sense that they do make a difference in our ability to attract good workers. But, there is no science to back any of this up.

Now consider your workplace health promotion or wellness program. Unlike all the other benefits your worksite offers, workplace health promotion programs have been studied for decades. There are hundreds and hundreds of rigorous scientific evaluations of the impact of these programs. There is more research on the impact of health promotion programs than anything else your company does. Granted, the research is not perfect-no research ever is.

But after decades of scientists evaluating programs, we have an enormous amount of very solid data that show the benefits of having a worksite health promotion program. I personally have published 75 research papers on the impact of worksite health promotion programs. And I am just one of hundreds of scientists in the field.

This research is what I will use to back up the 7 most popular reasons to have a worksite health promotion program.

1) Workplace Health Promotion Programs Improve Employee Health Behaviors

The core of every good health promotion program is behavior change. With the right education, skills, motivation, skills/tools, and social support, people change behaviors. Workplace health promotion programs are good at helping people adopt and maintain healthy behaviors. This is perhaps the biggest benefit of having a heath promotion program.

Healthy behaviors lead to lower health risks, and lower health risks lead to less chronic disease. With less chronic disease employees have fewer health care costs. It looks like this:

Many studies have evaluated the ability of workplace health promotion programs to improve health behaviors. Not every heath promotion program is able to show positive results. The ones that are well-organized and follow effective behavior change models show the best results. Here are the results of an evaluation I published recently. The 1,800 employees at this worksite reported their health behaviors at baseline, one year, and two years after the program began.

Source: Population Health Management article

Just about anybody can have healthy behaviors for a few days or weeks. The key is to maintain healthy behaviors for years. As soon as you stop having healthy behaviors you stop getting the benefits.

I like studies that go out for two years because the results are pretty conclusive by that time. If you can get your employees to participate in a good heath promotion program, chances are they will adopt and maintain healthy behaviors for years to come.

Most studies show that employees have better health behaviors. They eat healthier foods, eat smaller portions, exercise more often, smoke less, don't drink in excess, wear seat belts more often, and they're pretty good at controlling their stress. Workplace health promotion programs can also help alleviate depression and the symptoms of depression as well as improve life satisfaction.

Even the American Heart Association has completed an extensive review of the ability of programs to improve health and reduce cardiovascular risk.

Others have evaluated all of the research and reported that workplace health promotion programs, do in fact, have the ability to improve employee health. In 2013 researchers completed one of the most rigorous and comprehensive reviews of heath promotion programs. This study is called the Rand Report. Here is what the authors concluded:

We find that workplace wellness programs can help contain the current epidemic of lifestyle-related diseases, the main driver of premature morbidity and mortality as well as health care cost in the United States.

Soeren Mattke, Lead Author of the Rand Report

2) Workplace Health Promotion Programs Reduce Elevated Health Risks

The foundation of any good heath promotion program must be focused on helping employees adopt healthy behaviors.Eating and exercising are behaviors. Elevated blood glucose, high blood cholesterol, and high blood pressure are almost all caused by unhealthy diets and lack of physical activity. A few years ago I published the results of a randomized clinical trial that helped people improve their nutrition and physical activity.

We were stunned to learn that in as little as six weeks health risks could improve dramatically. Those who maintain healthy behaviors experience lower health risks for six weeks, six months, 12 months, and even out to 18 months after this program began.

When you change your diet, get active, and avoid tobacco, really good things happen. Boise School District is a WellSteps client and not long ago we published the results of their changes in health risks. After one year, a lot of employees who had elevated health risks at baseline, had reached healthy risk levels.

Source: JOEM

Reductions in elevated health risks are important. The New England Journal of Medicine reported that for every 1% drop in total cholesterol, the risk of having a heart attack dropped by 2 to 3%. For every one point drop in elevated diastolic blood pressure, there is another 2 to 3% drop in heart disease risk.

Low health risks are the foundation of good health, and workplace health promotion programs are a great way to help employees and their spouses avoid elevated health risks. There are hundreds of research papers that evaluated the ability of workplace health promotion programs to reduce elevated health risks. One particular study looking at almost 200,000 heath promotion program participants and showed that 5 0f 7 health risks improved after one year.

Another researcher looked at all of the published studies to get a consensus. This review showed that comprehensive workplace health promotion programs will have a significant impact on elevated health risks.

A Weakness of Workplace Health Promotion Programs

There is one weakness that almost all workplace health promotion programs have. After 30 years of evaluating dozens and dozens of programs it has become clear that it is difficult to impossible to get large groups of employees to reach and maintain a healthy body weight. The obesity epidemic is caused by a variety of cultural factors and helping employees lose weight has proven to be exceptionally difficult.

While the research suggests that helping people improve blood cholesterol, blood pressure, and blood glucose is possible, helping people lose weight and keep the weight off has proven to be hard to do. I'm the first one to admit that workplace health promotion programs are not very effective at helping people lose weight.

Just take a look at the body mass index (BMI)data in the table above. Those who are obese do lose some weight after a few years but not very much.

There is some hope. Recently, the RAND study showed some promising results:

Source: Rand Report

If the focus of your heath promotion program is to help individuals reach and maintain a healthy body weight you should prepare yourself to be disappointed. The unhealthy culture that surrounds most of us makes it extremely difficult to lose weight, in fact, most people in the United States and in the industrialized world gain weight every year.

So there are couple ways to look at this. Workplace health promotion programs are very effective at reducing elevated health risks like blood pressure, glucose, and cholesterol. But they are not very effective at helping people lose weight.

Without the impact of all the workplace health promotion programs in the world, obesity would be even worse than it currently is.

Workplace health promotion programs may not help your employees reach a healthy body weight, but they are helping your employees to stop gaining weight.

3) Workplace Health Promotion Programs Reduce Health Care Costs

There are almost 100 different studies that have looked at the financial impact of workplace health promotion programs. I have published six of these myself, and I have years of experience conducting some extremely complicated ROI studies. These studies are not easy to do and they take years to complete.

In 2001 I published the most comprehensive review ever completed on the financial impact of workplace health promotion programs.

That study alone are reviewed 100 different research papers. The ability of a heath promotion program to reduce healthcare costs depends upon how effective the program really is. Having an occasional lunch and learn about nutrition or just doing a biometric screening will not be enough to move the healthcare cost needle.

Comprehensive workplace health promotion programs that improve employee behaviors will see a bending of the healthcare cost trend. Most often they will discover that the savings from program participation will be greater than the actual cost of the program. Almost every one of these return on investment (ROI) studies show a positive return on investment. Researchers from Harvard recently published another summary of the worksite heath promotion ROI research.

Here is what they found:

Source: Health Affairs

Among the 22 different studies that looked at workplace health promotion programs and healthcare costs, the average return on investment was 3.27. This means that for every dollar that was spent on the program the company saved $3.27 because of reduced healthcare costs.

Last year researchers evaluated the impact of the WellSteps wellness program at a large school district. Here is the actual healthcare cost trend for this worksite. After four years of heath promotion this worksite is actually spending less on healthcare costs than it did before the program began. For every dollar they spent on heath promotion they saved $3.3.

Source: Merrill et al. 2015

Anyone who still thinks workplace health promotion programs don't improve health is choosing to completely ignore hundreds of peer-reviewed scientific research papers that say otherwise.

4) Workplace Health Promotion Programs Improve Productivity

Poor employee productivity can be defined as physically being at work but not working. This type of poor productivity is called presenteeism. It is estimated that the cost associated with presenteeism due to poor employee health is at least 2 to 3 times greater than direct health care expenses. While the estimated cost of presenteeism dwarfs the cost of health care, it does not receive the same level of scrutiny among employers preoccupied with controlling the direct costs of poor employee health.

There are a lot of reasons why employees have low productivity. They may not know how to use the equipment, they may be distracted by other employees, they may not know what they are doing, they may be tired, or they might be on Facebook. One of the main causes of presenteeism is poor health.

New understanding of presenteeism has been revealed in recent research published by the journal Population Health Management.

Smokers were 28% more likely to have high presenteeism than non-smokers. Employees with an unhealthy diet were 66% more likely to have high presenteeism than those who regularly ate whole grains, fruits, and vegetables. Employees who didn't exercise very much were 50% more likely to have high presenteeism than employees who were regular exercisers. These findings demonstrate that poor health behaviors are strongly associated with high levels of presenteeism.

In short, unhealthy individual lifestyle choices may result in substantially higher levels of lost productive work time.

This figure displays increased rates of high presenteeism among employees who smoke, don't eat healthy, or don't exercise regularly. Poor health behaviors eventually lead to elevated health risks and chronic diseases. The figure below shows how health risks such as excess body weight, elevated blood pressure, and high cholesterol increased the odds of having high presenteeism.

The other health conditions in this figure further paint the presenteeism picture-the presence of risk factors, pain, and chronic disease, especially chronic depression, dramatically increase the odds of having high presenteeism.

Looking at this graph, you can see that employees who suffer from neck/back pain are 79% more likely to have high presenteeism than employees who do not have neck/back pain.

These results confirm several ideas about the benefits of worksite heath promotion. Presenteeism is associated with poor health behaviors as well as elevated health risks and the presence of chronic disease.

Workplace health promotion programs that focus on helping employees have good health behaviors will eventually have an impact on productivity. I have written extensively about the connections between worksite heath promotion and productivity in a previous blo g.

5) Workplace Health Promotion Programs Can Decrease Absenteeism

There are over 50 papers that have looked at the connections between workplace health promotion programs and reduced absenteeism. Worksites with comprehensive programs can experience reduced absenteeism for a variety of reasons:

Employees with good health behaviors have lower absenteeism

Employees who can control their stress have lower absenteeism

Employees with healthy blood pressure, cholesterol, and glucose have lower absenteeism.

Employees who are not overweight or obese have lower absenteeism

I summarized all of these studies in one monster paper that was published a few years ago. You can read the nitty-gritty details of all 46 papers if you 're really curious.

Any heath promotion program that can reduce absenteeism will experience cost savings. Harvard researchers looked at the ROI of workplace health promotion programs as they relate absenteeism and demonstrated that for every dollar programs spend on heath promotion they can save $2.73 and reduce absenteeism.

Source: Health Affairs

Workplace health promotion programs have the ability to improve employee health and this can have an impact on whether or not individuals are absent from work. But there is another reason why these programs can have such a large impact on absenteeism. Employees who have high morale are significantly less likely to be absent from work.

6) Workplace Health Promotion Programs Can Help Improve Employee Recruitment and Retention

I confess there is no published scientific data that shows that workplace health promotion programs will make a significant impact on your ability to recruit and retain employees. There are a lot of factors that go into the decision to accept a job offer. It helps if you can offer a good salary and a rich benefits plan.

I had the privilege of visiting the VP of benefits at the Microsoft corporate office in Redmond Washington. If you are fortunate enough to land a job at Microsoft you will get an amazing Microsoft benefits package.

You'll get free wellness, free gym membership, onsite health clinics of every variety, and NO insurance premium-doesn't that sound great? All the large software/tech companies are offering heath promotion with their benefits plans. The do this because they are all fighting with each other to hire and retain the best workforce possible. A rich benefits package makes it easier to get the best employees.

I don't have any evidence that shows that having a heath promotion program will tip the scales when an employee is considering accepting a job. A Virgin HealthMiles/Workforce survey did find that about 87% of employees said they consider health and wellness offerings when choosing an employer. But compared to other defined benefits, wellness plans just don't have much sway in the employment decision process.

However, workplace health promotion programs do have a strong impact on retention. Retention is the ability a worksite has to retain its workforce. Rich benefits also have a powerful influence on retention, but a good heath promotion program can help keep employees loyal.

Personnel is the most important asset in every organization. When an employer offers a heath promotion program to its employees the company is saying, "We think you are an important part of this organization and we want you to be healthy, happy, and employed here for a long time". When you offer your employees a heath promotion program, you are showing them that you care about them.

You are letting them know you want to do everything you can to keep them in good health and optimal performance. Employees know when they are appreciated. They know when feel welcome and valued as important parts of the organization. That knowledge can do a long way toward convincing employees to stick around: they can go find another job somewhere, but will they get treated and valued the same way?

7) Workplace Health Promotion Programs Build and Help Sustain High Employee Morale

I'm going to let you in on a little secret. The WellSteps wellness solutions has a performance guarantee. After three years we guarantee that your heath promotion program will have a positive return on investment. The secret is that after three years almost nobody cares about the ROI.

That may have been a good reason to start their heath promotion program, but after employees start to engage, communicate with each other, feel valued and appreciated, the reasons for doing a program change. After three years we have found that our clients like to do heath promotion because they like the way it has changed their worksite culture.

Employees are obviously healthier but more importantly they are happier. This is another reason that doesn't have scientific research to back it up. We are probably never going to have a good study that can evaluate that question. What we do have, however, is experience with hundreds of clients that have migrated away from the ROI of heath promotion and have moved towards the value on investment (VOI) of heath promotion. I've blogged about this previously here.

The academic approach to workplace health promotion programs has limitations when we start talking about employee morale. As the CEO of WellSteps, a company with dozens of employees, I see the impact of our own heath promotion program in a very different light. Employee morale is a huge factor in the success or failure of any business and a good heath promotion program helps employees be happy and healthy.

Many of you have probably studied Maslow's needs hierarchy. The pyramid shown below shows the different needs that we have as humans. The most important and life sustaining needs are the bottom of the pyramid, the base of the pyramid.

These include things like food, water, shelter, social interactions, etc. Without these basic needs being fulfilled we could die or just suffer through life. The top half of the hierarchy shows the kinds of things we'd like to have once our basic needs have been met. Not everyone gets to fulfill these higher needs, and their lives are not as rewarding as they could be.

When you offer your employees a heath promotion program you are telling them that you respect them, you trust them, and that you want to help them be successful in life. Employees have high employee morale when they are allowed to be creative, solve problems, feel safe and appreciated, develop self-esteem, and achieve personal goals and aspirations. Employees are happy when they have a sense of control over their lives and their health.

In my opinion. this is one of the most powerful reasons to have a heath promotion program. Realistically, your employees don't care about your healthcare cost problem, they care about their own happiness. Your employees don't share your concerns about productivity or absenteeism. They care about having a fulfilling, enjoyable job.

Your worksite heath promotion program helps employees achieve all of their needs, both physical, social, and emotional. When it is all said and done, your employees want to feel loved and appreciated; really good things happen at work when they do.

Productivity goes up, customer service is outstanding, problems get solved, and people get creative. They like coming to work, they appreciate their employer, they work better with others, and they have high employee morale.

What is the financial value of having employees with high morale? It's probably impossible to make this calculation but reverse the question and ask it again. What does it cost your company when you have employees with poor morale? Complaints will go up, the quality of your product or service will suffer, and problems will multiply because poor employee morale can be contagious. Poor employee morale can be a company killer.

After 30 years of researching all of the benefits of a worksite heath promotion program, I have come to the conclusion high employee morale, while almost impossible to evaluate, is an extremely important benefit of heath promotion. Perhaps this is why many of the companies with outstanding workplace health promotion programs have dramatically better financial performance.

So What?

There is an enormous amount of research to support the benefits of workplace health promotion programs. A comprehensive program is going to improve employee health and improve your organization's bottom line. It is not going to make all your problems go away, but it is going to help you create a worksite culture of health. It will boost and maintain employee morale. With an effective workplace health promotion programs you will improve the lives of your employees and help drive the success of your organization.

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7 Reasons Workplace Health Promotion Programs Work (Here's the Proof)

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Think of the different benefits employers typically offer. These could include a retirement or pension plan, healthcare, paid time off, or maternity leave. These are designed to help your organization recruit and maintain qualified employees. Yet there is not a single published study that shows that offering these benefits has any measurable effect on a worksite's ability to recruit or maintain workers.

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Full-time employees in the U.S. work approximately 1,700 hours per year. With so much time spent at the daily grind, healthy habits can often fall by the wayside. To combat this, more than 90 percent of large employers and 73 percent of small employers sponsor wellness initiatives in the workplace. For many employers, these programs promise savings in the face of rising heath care costs, and for their employees, the opportunity to start or maintain healthy behaviors such as working out, getting flu shots and screening for high blood pressure.

Encouraging healthy behaviors while also driving down costs sounds like an easy win for all involved, but not everyone is on board with the idea. Critics believe these programs are costly, put employee privacy at risk and discriminate against employees if they cannot - or do not - participate. In fact, there have been several high-profile lawsuits charging that wellness programs are not, in practice, voluntary and that the protections outlined in the Affordable Care Act (ACA) are neither clear nor sufficient to ensure that employers comply with the Americans with Disabilities Act.

So, are workplace wellness programs worth it? We've summed up the main arguments in the chart below so you can decide for yourself.

PROS OF WORKPLACE WELLNESS PROGRAMS

CONS OF WORKPLACE WELLNESS PROGRAMS

Wellness Programs save money in the long run.

A well-received, peer-reviewed meta analysis (Baicker et al., 2010) of literature showed an average reduction of health care costs of $3.27 per $1 spent and a reduction of costs due to absenteeism of $2.73 for every $1 spent.

Studies also show disability, worker compensation and recruiting and training costs are decreased by workplace wellness programs.

Wellness programs cost a lot of money to run and do not have sufficient return on investment.

Recent studies have found that the return on investment in wellness programs to be a ratio of 1-to-1 or less. The results of the often-cited Baicker meta analysis research have not been replicated despite attempts.

Wellness programs benefit company culture and attract talent.

A Virgin Pulse 2014 Survey of Workplace Health Priorities found 87 percent of respondents agree that wellness programs positively impact company culture. It is thought that morale is enhanced as well as inter-employee relationships - leading to an overall improvement in working conditions. Furthermore, 88 percent of respondents cited workplace wellness programs as important when deciding on an employer.

Wellness programs are not, in practice, voluntary.

The ACA stipulates that participation in workplace wellness initiatives must be voluntary but does not describe a clear framework as to how that should be accomplished. In practice, employees may feel that wellness programs are mandatory because of the financial incentives and disincentives tied to participation.

Wellness programs improve health behaviors and outcomes.

Many companies and individual employees report improvements in healthy behaviors after participation in workplace wellness programs. For example, Johnson & Johnson followed employees for 15 years after starting its wellness programs. They found their initiatives contributed to a 75 percent reduction in the number of employees who smoke and a 50 percent reduction in the number of employees with high blood pressure and sedentary lifestyles.

Wellness programs are discriminatory and can deter people from seeking health care.

A study by Horwitz et al. (2013) showed that it is very difficult for workplace wellness programs to have significant returns without being discriminatory toward people with disabilities, chronic conditions or low socioeconomic status. This could mean those who would benefit most from wellness programs are discouraged from participating.

Wellness programs boost productivity and reduce absenteeism and disability claims.

A fitness program by telecommunications giant Pacific Bell decreased employee absences by .8 percent - saving the company $2 million annually.

A rigorous study of blue-collar workers found that comprehensive workplace wellness programs reduced disability by 14 percent over two years. The savings from disability payments alone was enough to cover the cost of the program.

Wellness programs are a violation of privacy.

Many employers collect biometric data through blood tests to collect aggregate information regarding their employees' health in terms of preventable chronic conditions, such as diabetes, heart disease and high blood pressure.

Many employees believe the collection of biometric data to be an infringement on their privacy and reject being "strong armed" into health behaviors by their employer.

There are compelling arguments on both sides of the workplace wellness debate. Companies will have to take a careful look at the pros and cons of workplace wellness programs and consult with health administrators to design workplace wellness programs or alternative strategies to control health care costs. Companies that decide to implement such programs must address the challenges of creating an effective program while preventing discrimination, ensuring privacy and keeping costs in line.

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The Workplace Wellness Debate: Should Employers Adopt These Programs?

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Full-time employees in the U.S. work approximately 1,700 hours per year. With so much time spent at the daily grind, healthy habits can often fall by the wayside. To combat this, more than 90 percent of large employers and 73 percent of small employers sponsor wellness initiatives in the workplace.

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HR professionals view employee wellness programs as an important part of the health benefits mix, but the value these initiatives bring to organizations has come under increased scrutiny. The debate on the financial efficacy of health-promotion efforts intensified during the fall of 2014 when the Equal Employment Opportunity Commission (EEOC) filed a lawsuit claiming that Honeywell International's wellness program was not voluntary and violated the Americans with Disabilities Act.

In early December, a judge declined to issue a preliminary injunction requested by EEOC attorneys to stop Honeywell from offering its employees cash incentives in 2015 for participating in the corporate wellness program. The case has grabbed the attention of business leaders throughout the country and is causing many employers to reconsider how they administer their wellness offerings.

"Everybody is concerned and watching to see what the outcome will be," said Gretchen Young, senior vice president for health policy at the ERISA Industry Council in Washington, D.C. "Many employers right now are not making changes to their wellness plans, [but] a lot are considering pulling back on incentives."

Cost and Efficacy

Concerns with the costs and the effectiveness of wellness programs seem to be on the minds of chief human resource officers (CHROs) as well, according to a recent survey conducted by the Consero Group, a senior-level management consultancy based in Bethesda, Md. During a November 2014 meeting in Washington, D.C., Consero polled 42 CHROs of Fortune 1,000 companies. Nearly half of the CHROs (48 percent) did not believe their organizations' wellness plans were effective, while 60 percent reported that the programs have not significantly reduced medical costs for their companies.

Even with the modest rise in health care costs over the past several years, sources familiar with the issue believe businesses have reached a tipping point and that the expense of providing medical benefits to workers has become unsustainable. Cost-containment efforts therefore are putting more pressure on wellness programs to deliver on the promise of reducing health care expenses. However, as the CHRO survey and other recent studies have shown, wellness plans may not be producing the return on investment (ROI) that employers expect and need.

In 2013, the Rand Wellness Programs Study surveyed approximately 600,000 employees at seven large U.S. employers and found that wellness programs were having little if any immediate effects on the amount employers spend on health care. As a follow-up, the Rand Corp.'s researchers conducted an in-depth review of PepsiCo's wellness program and released the results in January 2014. The study revealed that PepsiCo's wellness plan was made up of two components-disease management and lifestyle management. The Rand researchers found that:

* The disease management component, which focused on helping employees who have chronic diseases like diabetes and hypertension, had a very strong ROI, and that PepsiCo realized a savings of $3.78 for every dollar it spent on the disease management program.

* The lifestyle management component, on the other hand, did not reduce costs by any significant amount. Lifestyle management programs typically focus on identifying employees with potential health care risks, such as tobacco use, high blood pressure, obesity and diabetes.

Biometric Screenings Criticized

In many corporate wellness programs, employers offer workers financial incentives to get screened for certain health care risks. Many of the screening procedures, such as those that measure body mass index, blood sugar levels and cholesterol, can be expensive, and debate on effectiveness of the tests in reducing costs and changing employee behavior has intensified as health care expenses continue to rise.

"The evidence is pretty conclusive that wellness programs with clinically driven components that rely on biometric screening do not provide the returns and cost reductions that employers have been promised for years," said Vik Khanna, a health benefits consultant based in St. Louis and co-author of the e-book Surviving Workplace Wellness (THCB Press, 2014). "If you look at the Fortune 1,000 companies that have made biometric and clinical screening a big part of their wellness plans, the numbers simply do not justify the cost. The return on investment for these type programs just isn't there, and the impact on improving the overall wellness of program participants has been negligible."

Khanna contends that biometric screenings such as checking cholesterol levels and blood pressure identify health risks and conditions that typically affect older workers. "So, employers end up spending a lot of money on these screens upfront for very little immediate result," he said. "Most of the issues that these tests screen for are conditions that primarily affect people who are in their 60s or 70s. Therefore, the actual cost impact of these chronic conditions is delayed or won't be felt at all as workers move on to other jobs."

The goals of most corporate wellness plans that use clinical screenings are to moderate or change employee behaviors and to help workers develop healthier lifestyles. However, sources familiar with this issue agree that these goals are rarely met.

"If the objective is to change employee behavior, then a biometric screening is a pretty ineffective way to do it," Khanna said. "All the screening does is identify potential health care risks. And if the goal is to change behavior, then wellness plans must find ways to engage and encourage employees on adopting healthy lifestyles."

The practice of offering biometric screenings has many defenders, of course. For instance, writing recently on the Health Affairs Blog, Ron Goetzel, director of the Emory University Institute for Health and Productivity Studies, argued that "Biometric screenings are important for collection of baseline health risk data and are often viewed as an added value by employees participating in workplace health promotion programs."

Taking a Holistic Approach

A growing number of employers are exploring ways to better engage workers and to help them become healthier and more productive. In short, more businesses have begun to focus on a more holistic approach to wellness.

"More and more, we are hearing the term 'well-being' instead of wellness," said LuAnn Heinen, a vice president at the National Business Group on Health and director of the Institute on Innovation in Workforce Well-Being. "Well-being focuses on the mindfulness of what it takes to live a healthy lifestyle, and the mission of well-being programs is to find ways that help stressed, hardworking employees lead happier, healthier and more productive lives."

As the scope of well-being programs expands beyond health care screenings, employer focus has begun to shift away from "return on investment" and toward "value of investment" (VOI), Heinen said.

"We are definitely hearing the term VOI much more now," she noted. "While it can examine metrics such as reductions in health care costs, the VOI model also takes into account measurements such as reduced absenteeism, increased productivity, turnover and job satisfaction of employees who participate in the well-being program."

Promoting Engagement

When employers demonstrate that they truly care for the well-being of their workers, employees tend to respond favorably, according to Heinen and Khanna.

"If done correctly, it is an excellent way to reach out and engage employees," Khanna said. "Employers must be respectful of their employees and find ways that engage and energize them."

Often, this can be something fairly simple and cost-effective, such as providing coupons for or discounts on healthy food options like fruits and vegetables at a local grocery store or farmer's market, Khanna added. Since these types of program offerings can be a hit-or-miss proposition, feedback is crucial to determine what offerings resonate with employees.

"The key is finding what works best and what employees respond to," Khanna said. "Focusing on lower-cost options that actually build and sustain healthy habits, I believe, is the future of corporate wellness programs. Wellness programs that rely heavily on expensive clinical-based biometric screenings will soon be a thing of the past," he predicted.
Bill Leonard is a senior writer for SHRM.​

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Critics Challenge Corporate Wellness Program ROI

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HR professionals view employee wellness programs as an important part of the health benefits mix, but the value these initiatives bring to organizations has come under increased scrutiny. The debate on the financial efficacy of health-promotion efforts intensified during the fall of 2014 when the Equal Employment Opportunity Commission (EEOC) filed a lawsuit claiming that Honeywell International's wellness program was not voluntary and violated the Americans with Disabilities Act.

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"Yes, every single wellness outcome which has been made public is made up."

"90% of wellness programs being sold to companies are "counterproductive at worse and worthless at best."

The Wellness Critics

The Wellness Critics Are Bullies

These two actual quotes from a wellness critic are so outlandish that they don't even deserve a response from anyone in the wellness industry. And this is just the tip of the iceberg. The bullying tactics employed by these critics have been directed at WellSteps, other wellness vendors, and highly respected researchers all of whom have chosen the high road and remained silent. After all, how do you respond to outrageous statements such as these? No response has been the response of choice. It is time to share the truth about the bullying tactics used by wellness critics.

I have been in the wellness industry as a professor and CEO for nearly 30 years. I have published over 75 research articles and 7 books on this topic. Wellness is all I have ever done as a professional and I am not alone. Nearly everyone I have ever met in the wellness industry from vendors, academics, and professionals to the people who run large wellness organizations such as HERO, WELCOA, the Health Project, and many others are all smart, caring, thoughtful and genuinely wonderful people.

I believe that the men and women who work in wellness industry are some of the finest people on the planet. The most rewarding part of my career has been the associations I've made with wellness people all around the world.

Wellness critics on the other hand, by saying "every single wellness outcome which has been made public is made up," have basically called every wellness professional- a big fat liar. This ridiculous statement implies that there is not one wellness professional with scruples. For this criticism to be true, every wellness researcher, journal reviewer, journal editor, and academic institution associated with wellness research on the entire planet, would have to have manufactured or accepted or published fake research data. Moreover, this global wellness conspiracy would have been initiated decades ago and kept secret for nearly a century. Let that sink in for a moment.

Wellness critics who make public statements like this are like the playground bully trying to pick a fight- it doesn't matter with whom. Unlike these wellness bullies, the wellness professionals who have led the wellness industry for decades, have conducted themselves with professionalism and decency.

The next time you see a blog, a post or a tweet from one of these critics, ask yourself this question - "is this an attempt to bully?" If they have nothing constructive to say, then they are part of the problem. What follows are several ways that these wellness critics have bullied.

Extortion? Really?

Not long ago, other wellness vendors and professionals and I received an email from the wellness critics. The carefully crafted letter basically said that there would be a targeted attack published on the web. But if you paid the wellness critics $20,000, they would back off. Here are a couple quotes from one of the emails:

"You may pay us $20,000 to be removed" and "$20,000 is a very low price to pay"

This is extortion. I had never received a letter like this before. All of the national leaders in the wellness industry were stunned by this brazen demand. It was at this moment that most of us knew this wasn't normal critic behavior, this was something more sinister. Extortion? Really? In defense of critical dialogue, we live in a free country so any respectable critic in any industry can try to drive improvement by discussing things they don't like... but extortion? This was a game changer.

It makes it very clear that the wellness critics are not interested in observing and challenging the wellness industry to improve. In fact, extortion places their motives squarely in the realm of bullying. I have found myself wondering many times, "What exactly do the wellness critics want?" Since they don't really act like critics, they must want something else. I think Alfred understood this behavior quite well:

So after 30 years in the wellness industry, we are now all being challenged by a gang of wellness bullies. It would be one thing to invest a significant amount of time publishing twisted facts, insults, and criticisms which these critics tend to do. But trying to extort money is another thing entirely. Extortion is a tactic only used by bullies. When confronted about this one wellness critic angrily responded:

The Wellness Critics Send Lots of Threatening Letters

The wellness bullies want to get the wellness researchers fired from their jobs. During the past few years the wellness bullies have sent slanderous letters to deans, presidents, and department chairs at many of the country's top universities. The purpose of these letters is to get certain health and wellness professors and researchers fired or reprimanded. I know several researchers who have received such letters and there are likely many more.

These letters claim that the professors have failed to conduct their science correctly, falsified their data, and taken kickbacks from the wellness industry. All of these researchers are some of the nation's most accomplished research scientists with the nation's highest academic credentials and thousands of published research projects. Few academics are able to attained this level of research expertise. Here is the actual letter that the wellness bullies sent to one dean.

The wellness bullies don't actually publish research yet they claim to understand research methods better the scientists who do. You have to be pretty bold to call out one of the nation's best research scientists. Again, you would be hard pressed to find any peer-reviewed, empirically-based scientific papers published by these wellness bullies. However, they seem to be adept at writing blogs and trolling the web with inflammatory comments.

As expected, these critic letters have fallen on deaf ears. The universities who received these letters accurately and predictably recognized them to be nothing more than the sad rantings of a wellness bully. These same wellness critics claim that blogs are more important and accurate than the peer-reviewed science that is published in scientific journals. But this desire to rant and rave against academia raises a troubling question.

Who gets so upset by the results of a peer-reviewed research article that they would spend several months trying to get the authors of those articles fired? Would a normally adjusted person write such a letter? Who would even do that? This pattern of bullying behavior actually casts a considerable shadow on the credibility of these critics. The wellness industry, like any other industry needs civil and constructive dialogue to help drive improvement, but these actions are far from civil.

The Wellness Bullies Only Throw Rocks

Wellness bullies love to throw rocks at the research that is published. This is a common bullying tactic. All research studies have flaws. There is no such thing as a perfect study. This means that published scientific papers can produce entirely different results. This is why we so heavily depend on scientific consensus. Because there is never a perfect scientific paper, wellness bullies tend to cherry pick the scientific literature and ignore the findings that don't fit their criticisms.

This is the same method used by the tobacco industry when they said that there was "no randomized clinical scientific evidence that smoking is harmful" and they are correct. There has never been a randomized clinical trial studying the effects of smoking on humans but there is a body of evidence that is over 200 years old. Wellness bullies throw rocks at wellness research because every research study has weaknesses which they are quick to identify. The wellness industry has outstanding randomized clinical trials like the ones here and here that prove the effects of wellness, but this is completely ignored by the critics.

The wellness bullies are not interested in the truth, they are only interested in fighting. Despite the overwhelming scientific consensus provided by meta-analyses and literature reviews, wellness bullies cherry pick the weakest results and throw rocks.

As mentioned, valid criticisms of the wellness industry are needed. There is a constant effort to improve by wellness researchers, WellSteps and probably every other wellness vendor on the planet. Criticism provides valuable input that companies can use to improve. Researchers get criticism from journal editors and reviewers, professors get criticism when they apply for tenure, and vendors get useful criticism from customers.

Valid criticism is almost always a powerful force for good. It can be used as a constructive and meaningful way to improve. Unfortunately, the wellness bullies are not interested in constructive and meaningful ways to improve, they are only interested fighting and throwing rocks. To them, picking fights and watching the world burn is reward enough.

Wellness bullies thrive on disagreement. Truthfully, the scientific method provides much opportunity for that. But the wellness bullies pick away at the wellness research trying hard to cast doubt on the entire industry by pointing out reasons to doubt a few papers. Again, this is the same approach used by the tobacco industry in its effort to stop the regulation of tobacco. The wellness bullies do not care about preventing, reversing or treating chronic diseases, they only care about themselves. That's what bullies do best.

The wellness bullies are adamant that only they understand what wellness should be. They want everyone to believe that if you listen to anyone else, you have gone astray. They want you to believe that all wellness professionals are part of a gigantic conspiracy to steal money from unsuspecting customers. They claim that employee wellness programs are destroying the health of Americans and that they, the wellness bullies, are the only enlightened gurus on the planet.

If the wellness bullies are correct, then they must think that all the leaders of every company in America with a wellness program are idiots.

The Wellness Bully Code of Conduct

Even though the wellness bullies claim that the wellness industry is a sham, they have announced a new code of wellness conduct. I'm very interested in improving the quality and effectiveness of wellness programs. I don't know any wellness professional who would say otherwise. But I think I speak for all of us when I say that I have no interest in a code of conduct written by a gang of bullies. The wellness industry does not need a code of conduct, we have HIPAA and other laws to do that. What we really need is a code of conduct for wellness bullies. It could look something like this:

Wellness Bully Code of Conduct

1. Don't use extortion or blackmail. That's not nice.

2. Don't write threatening letters to everyone you don't like.

3. Instead of whining, how about proposing some realistic solutions?

4. Don't throw rocks. That just ticks people off.

5. Don't pick fights with everyone you confront. Nobody likes a bully.

6. A life spent being angry at everyone is a life utterly wasted.

Stand Up Against the Wellness Bullies

I have been blessed to work in an industry that transforms and improves the lives of millions of individuals. Each day I give thanks for the opportunity I have to help people improve their health and live long, high-quality lives. I can't think of a more rewarding way to live my life. Most wellness professionals probably share these same feelings.

Next time you see a blog post, comment, email, or snide remark from one of the wellness bullies make a comment. Challenge them to suggest some positive solutions instead of just throwing rocks. Nobody likes a bully.

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"Yes, every single wellness outcome which has been made public is made up." "90% of wellness programs being sold to companies are "counterproductive at worse and worthless at best." The Wellness Critics These two actual quotes from a wellness critic are so outlandish that they don't even deserve a response from anyone in the wellness industry.

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Improving workforce health and productivity

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Improving workforce health and productivity

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willis towers watson health and productivity

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willis towers watson health and well-being

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willis towers watson health and wellness

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2015/2016 Staying@Work - United States research findings

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U.S. findings of Willis Towers Watson's 2015/2016 Staying@Work Survey, a global study of employers' health and productivity strategies

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Many organizations think that employee well-being is, well, none of their business. And there's some sense to that -- well-being does seem ill-defined, private, and ultimately unmanageable. According to Tom Rath, leader of Gallup's workplace research and leadership consulting practice, and Jim Harter, Gallup's chief scientist for workplace management and well-being, it's not. But well-being is gravely misunderstood.

Rath, Harter, and teams of Gallup researchers spent years studying well-being to find out what it is and how to increase it. They surveyed people in more than 150 countries; partnered with leading economists, psychologists, sociologists, and physicians; and conducted and studied in-depth well-being research. Ultimately, as Rath and Harter wrote in their New York Times and Wall Street Journal bestseller Wellbeing: The Five Essential Elements -- well-being is the fulfillment of five distinct factors. (See sidebar "The Five Essential Elements of Well-Being.")

The Five Essential Elements of Well-Being

For more than 50 years, Gallup scientists have been exploring the demands of a life well-lived. More recently, in partnership with leading economists, psychologists, and other acclaimed scientists, Gallup has uncovered the common elements of well-being that transcend countries and cultures. This research revealed the universal elements of well-being that differentiate a thriving life from one spent suffering. They represent five broad categories that are essential to most people:

Rath and Harter discovered these core dimensions to be "universal and interconnected elements of well-being, or how we think about and experience our lives." When those factors are fully realized, people thrive -- and so do businesses.

In the U.S., the average sick day costs a business about $348 in lost productivity, according to the Bureau of Labor Statistics and a study published in 2003 in the Journal of Occupational and Environmental Medicine. When we adjust this number because people are sick on weekends and non-working days and because some work does get done on sick days, the cost is still approximately $200 per sick day. But people with high levels of well-being get sick less often; as a result, they cost their organizations less.

Among the most "suffering" employees -- those with the lowest well-being scores -- the annual per-person cost of lost productivity due to sick days is $28,800. For workers who are at the midpoint of the "struggling" zone, the cost is $6,168. But for employees with the highest levels of well-being -- those with the highest scores in the "thriving" category -- the cost of lost productivity is only $840 a year.

Another recent study compared the disease burden -- or the incidence of high blood pressure, high cholesterol, heart disease, back pain, diabetes, depression/anxiety, and sleep apnea/insomnia -- of 662 people with varying levels of well-being. For each disease, Gallup entered the average annual cost into its database -- and after adjusting for demographic differences -- found that respondents in the thriving category averaged $4,929 per person annually in disease burden cost versus $6,763 a year for respondents in the struggling and suffering categories. That's a 37% per-person cost differential. In other words, for an organization with 1,000 workers, thriving employees cost their employers $1.8 million less every year.

And if that weren't startling enough, Gallup tracked changes in disease burden from 2008 to 2009 for the same group of 662 people. Gallup studied the relationship between well-being and recent changes in disease burden and found that the average annual new disease burden cost for people who are thriving is $723, compared with $1,488 for those who are struggling or suffering.

Clearly, it's in an organization's best interest to keep its employees healthy. But well-being is comprised of five interrelated elements. Pushing one dimension of well-being at the expense of the other elements won't improve well-being very much. To reap the most benefits from thriving employees, organizations should pay attention to all five elements.
Career and engagement
Career Well-Being is a natural place to begin -- and it might be the best place to start too. "Most people don't realize how closely intertwined their Career Well-Being is with their overall evaluation of their life and daily experiences," says Harter. "Our research suggests that this may be the single most important element of one's well-being."

Simple motivational techniques, such as recognition for goal achievement, go a long way toward enhancing Career Well-Being.

Career Well-Being doesn't necessarily refer to paid work. Rath and Harter note that stay-at-home parents and devoted volunteers can have high levels of Career Well-Being. But to be engaging, work does have to provide "interest and purpose and the chance to use your strengths regularly," as Harter says. "We spend more of our waking hours at work than anywhere else, so work really needs to provide that outlet." That's why, Rath and Harter suggest, it's a seminal element of well-being. And that might also be why they found a strong connection between employee engagement and well-being. Engaged employees have a sense of purpose and get to do what they do best every day. (See "Feedback for Real" in the "See Also" area on this page.)

Whether or not engaged employees have high levels of well-being -- though it's realistic to expect that engagement naturally promotes well-being -- these workers are an organization's best asset. Workgroups with many engaged employees realize substantially higher levels of customer engagement, productivity, and profitability compared to teams with less engaged employees. And engaged teams have less absenteeism, lower turnover, fewer accidents on the job, less theft or unaccounted for merchandise, and fewer quality defects.

Engaged employees who are thriving in Career Well-Being are twice as likely as actively disengaged employees to be thriving in their lives overall. In contrast, people in disengaged workgroups are nearly twice as likely to be diagnosed with depression, have higher stress levels, and are at greater risk for heart disease. And perhaps not coincidentally, engaged employees are 21% more likely than actively disengaged employees to get involved in a wellness program offered by their employers. This relationship between engagement at work and involvement in wellness programs is consistent across body mass index (BMI) groups (normal, overweight, and obese) and people with and without disease burden. In other words, even among people who are classified as obese and those who have pre-existing disease burden, those with higher Career Well-Being are more likely to become involved in wellness programs that are offered.

There are many ways organizations can improve Career Well-Being. Leaders and managers can help employees connect their work to a higher purpose and focus on employee strengths, which can reduce active disengagement. Even simple but powerful motivational techniques, such as recognition for goal achievement, go a long way toward enhancing Career Well-Being.
Socializing is good for business
While considering the performance boost inherent in higher Career Well-Being, employers should also think about employees' Social Well-Being. Even though socializing may sound antithetical to workplace productivity, Gallup found that socializing at work is actually good for business. "Among those with thriving Social Well-Being," says Rath, "49% were thriving in their careers." Moreover, Gallup has found that employees who say they have a best friend at work are seven times more likely to be engaged in their work. Those who don't feel that way have a mere 1 in 12 chance of being engaged. Yet only 5% of workers strongly agree that their organization helps them build stronger personal relationships. (See graphic "The Benefits of the Water Cooler.")

Nevertheless, it can still be galling for managers to watch employees chatting around the coffee pot when they should be working. The research, however, indicates that office chit-chat serves a productive purpose. "We cite an interesting finding in the book that came from a team at MIT," says Harter. "They studied people who were just walking around different office settings and found that the social cohesiveness created by conversations that weren't at all work-related actually helped boost workplace productivity." (See "News Flash: Workplace Socializing Is Productive" in the "See Also" area on this page.)

Furthermore, Gallup's research shows that to have a thriving day, people need six hours of social time. Few organizations would condone six hours of surfing Facebook on the company dime, but employers can promote Social Well-Being and organizational goals through social activities -- such as mentoring programs and development opportunities -- that can produce important business results.
The money issue
It's logical to assume that organizations are central to employees' Financial Well-Being -- employers issue paychecks, after all, and people rely on those paychecks to meet their needs. But Financial Well-Being is more about financial security than monetary compensation. In fact, Gallup's studies show that financial security has nearly three times the impact of income alone on employees' overall well-being.

That's why pay itself doesn't necessarily correlate to engagement or well-being -- and neither do pay raises. However, if employees don't "perceive their pay to be fair and equitable," says Rath, "it can lead to disengagement and cause them to leave when a better job comes along." There's also the impact of financial worries on employees' mental and physical health. Low Financial Well-Being can lead to stress, anxiety, insomnia, headaches, and depression. And those are costly problems.

Ironically, most organizations don't seem to promote their employees' Financial Well-Being.

Ironically, most organizations don't seem to promote their employees' Financial Well-Being very well. Only 6% of employees strongly agree that their organization does things to help them manage their finances more effectively. But business might be uniquely -- perhaps perfectly -- situated to improve employees' Financial Well-Being. Financial security is integral to well-being, and most organizations offer investment, profit sharing, or savings opportunities.

One way organizations can improve their employees' Financial Well-Being is to make the default setting of savings programs opt-out rather than opt-in. For example, most employees won't participate in a retirement plan if they have to consciously opt in. But when the default is for employees to be automatically enrolled, more than 80% participate in the retirement plan.

Furthermore, according to Rath and Harter, spending money on experiences or on others does more to increase people's Financial Well-Being than spending on things or on themselves. "With experiences, you get a lot of value. There's the anticipation of the experience beforehand, for months beforehand sometimes," says Rath. "Then you get the actual experience itself. And then you usually have fond memories of the experience afterward." For that reason, it might be wise to encourage workers to use their vacation time for actual vacations.
Physical effects
Clearly, doing things like encouraging vacations offers psychic benefits. But Physical Well-Being matters too. As insurance costs have increased, many organizations have made efforts toward improving health in the workplace, and that's wise. Those efforts will be even more effective, however, if the organization reinforces healthy behaviors by making healthy choices easy and unhealthy choices hard. Gallup found that only 9% of U.S. employees say it is very easy to find healthy food at their workplace, and fewer than 5% say their organizations offer financial incentives for leading a healthier lifestyle.

While many leaders focus on the direct costs associated with paying for their employees' medical care -- such as prescription drugs, doctor visits, hospital stays, and insurance premiums -- employees with low Physical Well-Being could be taking an even larger economic toll. When someone with struggling Physical Well-Being shows up for work, it is highly unlikely that he or she has the energy to achieve as much as an employee with thriving Physical Well-Being can. And employees with high Physical Well-Being simply have more energy and get more done in less time. They are also more likely to be in a good mood, thus boosting the engagement of their colleagues and customers.

Offering incentives for lowered cholesterol and providing more vegetables in the cafeteria is a good place to start. But subtler changes can help too -- and can be as simple as designing workspace layouts so people have to walk a little farther every day, sponsoring workgroup athletic events, or hiring a chef for a monthly demonstration of healthy cooking. Organizations can't mandate health, but they can direct employees to changes that outlast the workday.
Community outreach
Organizations can also direct employees to look outward into the larger community. That's because having employees who are thriving in Community Well-Being improves an organization's image and increases its positive impact on the community. On the other hand, when organizations run their business in isolation, they miss out on potential gains in Community Well-Being for their employees and organization.

This aspect of well-being may be the most familiar to business: Organizational leaders have a long history of service in their communities, and many organizations actively support local philanthropic projects -- and sometimes their employees' chosen charities as well. When organizations invest in employees, employees contribute more to their communities. In one study, Gallup found that people in the most engaged workgroups (those in the top quartile of Gallup's employee engagement database) were 56% more likely to give money to the community, and they gave 2.6 times more money than people on less engaged teams (those in the bottom quartile).

Corporate support for community initiatives can result in positive customer relations and recruiting outcomes. Such behaviors can also improve employee well-being by creating the opportunity for social connections and local involvement.
Improving well-being
Some organizations offer health promotion programs. Others actively encourage giving back to the community through donating time or money. And a few take a hand in encouraging employee Financial Well-Being. But for the most part, the crucial activities that promote well-being are left to employees.

Because employee well-being has such a large impact on organizational well-being, businesses would be wise to measure and manage it. Fortunately, many organizations do have programs in place that affect well-being. But the well-being factor -- if it's recognized at all -- isn't leveraged as well as it could be. Businesses that manage well-being consciously, consistently, and with an eye toward improving key outcomes are more likely to have a profound influence on organizational and employee well-being.

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Many organizations think employee well-being is none of their business. That's understandable: Well-being does seem ill-defined, private, and ultimately unmanageable. But according to the authors of a new national bestseller, executives should care about employee well-being because it's good for people and for productivity.

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Why Your Workplace Wellness Program Isn't Working

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Why Your Workplace Wellness Program Isn't Working

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Gallup's research shows a clear link between employee engagement and well-being, with managers serving as a conduit between the two.

These days, doctors aren't the only ones interested in well-being. Banks, pharmacies, grocers, and other businesses are introducing programs designed to enhance their customers' wellness. But of all the places you go each day, your workplace may have the greatest influence on your well-being. And the person who can best help you achieve results is someone you probably least expect: your manager.

Many employers have hopped aboard the wellness bandwagon in recent years, recognizing that they can play an influential role in helping employees curtail unhealthy behaviors that can lead to costly chronic conditions. A recent RAND Corporation study found that more than 85% of U.S. companies employing 1,000 people or more offer some sort of workplace wellness program. It's safe to assume that these companies genuinely want to help their employees lead healthier lives while seeing a healthier bottom line too. Not only do employers spend a fortune subsidizing employees' healthcare costs, but they also see greater productivity and fewer missed workdays from employees with higher well-being.

The Gallup-Healthways Well-Being 5

Gallup and Healthways have developed a comprehensive, definitive source of well-being measurement, the Gallup-Healthways Well-Being 5. This scientific survey instrument and reporting experience measures, tracks, and reports on the well-being of individuals and organizations. The five essential elements of well-being are:

Purpose: liking what you do each day and being motivated to achieve your goals

Social: having supportive relationships and love in your life

Financial: managing your economic life to reduce stress and increase security

Community: liking where you live, feeling safe, and having pride in your community

Physical: having good health and enough energy to get things done daily

Yet simply offering a wellness program -- no matter how well-intentioned -- provides no guarantee of improving employees' well-being. Workers must be aware the program exists and be persuaded to use it -- and that's where things get tricky. Though more than 85% of large employers offer a wellness program, Gallup research shows that only 60% of U.S. employees are aware that their company offers a wellness program -- and only 40% of those who are aware of the program say they actually participate in it. The upshot is that at companies that offer wellness programs, only 24% of employees are participating. For companies that provide these programs, it might be time for a checkup.
The manager's role in improving employees' well-being
Clearly, companies must do more work to close the awareness and participation gaps that plague workplace wellness programs, and this is where managers play a vital role. Managers are uniquely positioned to ensure that each of their employees knows about the company's wellness program, to encourage team members to take part, and to create accountability for results.

Gallup's research shows a clear link between employee engagement and well-being, with managers serving as a conduit between the two. Managers account for at least 70% of team variation on employee engagement. And engaging employees is vital to getting them involved in company-sponsored initiatives, because engaged workers are 28% more likely to participate in a wellness program offered by their company than are average employees. And research findings suggest a contagion effect; direct reports of managers with high overall well-being are 15% more likely to have high overall well-being six months later.

It takes great managers to engage employees. Over the past decade, Gallup has worked with hundreds of organizations to help their managers create engagement and boost employees' well-being. To measure engagement, we ask employees to respond to 12 statements, including whether their supervisor (or someone at work) seems to care about them as a person. This statement in particular reveals whether workers feel that their manager truly cares about their well-being. Those who agree with it are more likely to be top performers and to produce higher quality work, and they are less likely to get sick, change jobs, or be injured at work.

But before managers can talk to employees one-on-one about their well-being, they must first build trusting relationships with their direct reports so team members feel comfortable discussing sensitive topics and setting health-related goals with them. This can be a challenge. A 2008 Gallup study revealed that, on average, employees find spending time with their boss about two to four times as unpleasant as spending time with friends. Men in particular report high levels of stress and low levels of happiness when spending time with their managers.

Too many company wellness programs focus solely on Physical Well-Being.

Managers who engage their employees have an edge when it comes to boosting workplace well-being, though. Engaged employees are more than two times as likely as actively disengaged employees to say they are very or somewhat comfortable discussing their well-being with their manager.
Engagement isn't enough to guarantee well-being
Though engagement is essential to creating a culture of workplace well-being, it's not enough on its own to create high well-being in all five elements. When employees are engaged, they're twice as likely as average employees to have thriving well-being in four or five elements, but two-thirds of engaged employees still struggle or suffer in two or more of the five elements.

What's more, the five well-being elements are interdependent and reinforce one another. When employees are thriving in multiple elements, it becomes easier for them to accomplish things that are in their own best interest, such as maintaining good physical health. If you have thriving Social Well-Being, for example, it's more likely that people you care about will be interested in your health. People with more daily stress make worse decisions in the moment. But if you have thriving Financial Well-Being, you will have less daily stress, which makes it more likely you will not fall back on instant gratification that may work against your long-term health interests.
Well-being is more than physical health
Companies are most successful at creating a culture of well-being when they provide managers with the right tools for a holistic, multifaceted approach. Workers are more likely to thrive when their companies and managers address their needs in each of the five elements, rather than simply focusing on Physical Well-Being interventions, such as programs that encourage employees to exercise or quit smoking.

Yet too many company wellness programs focus solely on Physical Well-Being, leaving employees to languish in the other four elements. Maximizing workplace initiatives to encompass all five well-being elements will pay dividends by helping companies improve their bottom line and outperform competitors. When comparing adults who are thriving in just Physical Well-Being with those thriving in all five elements, those in the latter group:

report 41% fewer unhealthy days

are more than twice as likely to say they always adapt well to change

are 36% more likely to say they always fully bounce back after an illness

are 23% more likely to donate money

are 43% more likely to have volunteered

are 65% less likely to be involved in a workplace accident

are 81% less likely to look for a new job when the job market improves

Workplace wellness plans aren't cheap. RAND estimates that these programs cost U.S. companies a combined $6 billion a year. But if they're done right, they have the potential to offset rising healthcare costs and build a more productive workforce. To ensure that wellness programs achieve this potential, companies must regularly audit their wellness initiatives to determine whether employees are participating in and benefiting from them. If they aren't, it's vital to find out why. An ineffective program drains financial resources, erodes credibility, and yields no return on investment.
What businesses can do
To determine whether their company's wellness program is making a difference at key organizational levels, leaders must be able to answer yes to these questions:

Culture: Do my company's programs encompass all five well-being elements? Does our organizational culture support our wellness initiatives? For example, is it socially acceptable in our organization for employees to exercise in the middle of the day or to leave early to participate in a charitable function?

Leaders: Do all my company's leaders support the well-being initiative? Do they regularly communicate the value of the program and reinforce how it fits with the organization's purpose and brand identity? Do they consistently model the behaviors that the program seeks to impart?

Managers: Are all managers successful at engaging their teams? Do they create the time and focus for employees to participate in the right company-sponsored programs to develop their well-being? Do they help their team members set goals to improve their well-being?

As long as healthcare costs continue to skyrocket -- and diabetes, heart disease, and other preventable conditions remain a threat to public health -- wellness programs will continue to proliferate. U.S. companies that promote wellness are on the right track to help workers control their healthcare costs and lead more productive lives, but their wellness programs are probably not as effective as leaders want them to be.

Companies can improve the prognosis for better results if they enlist managers to promote well-being initiatives with their teams and in one-on-one conversations with their employees. Expanding wellness programs to track, manage, and enhance employees' well-being in all of the five elements can help companies reduce healthcare costs while improving employee performance and customer engagement.

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Why Your Workplace Wellness Program Isn't Working

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Gallup's research shows a clear link between employee engagement and well-being, with managers serving as a conduit between the two. These days, doctors aren't the only ones interested in well-being. Banks, pharmacies, grocers, and other businesses are introducing programs designed to enhance their customers' wellness.

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Briefcase Project - Constructing a Driving Question

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Resources on posters, email lists, and wellness initiatives to start

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Work for Wellness is a statewide program that aims to bring wellness into the workplace. And since most people spend a large portion of their day at work, you have the opportunity to create a culture that values and promotes healthy lifestyle choices.

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The Social Ecological Model and Physical Activity Interventions for Hispanic Women With Type 2 Diabetes - A Review

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Social network theory in the behavioural sciences - potential applications

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To help you achieve the best results with the HERO Scorecard we have provided a brief planning process for your use:
Many Scorecard participants have found that one of the key benefits of completing the Scorecard comes from bringing together health and well-being stakeholders from different departments within their organizations to discuss how best to respond to the questions. Collaborating with different stakeholders within the organization may result in more accurate Scorecard responses, enhancing the level of collaboration between health and well-being stakeholders, and identification of new opportunities for integration across programs.

To review the Scorecard questions prior to submitting your responses to the online version, you can download a PDF version (or International PDF version) and consider which individuals within your organizations would best contribute to a response. If possible, set up a meeting with this group and work through the PDF version together. If that's not practical, ask them to fill out the relevant sections of the Scorecard and return it to you.

Once you've collected the responses and have a complete set of answers, you're ready to complete the online Scorecard for your organization. (We cannot accept PDF versions of the Scorecard.) It is important to save and/or download a copy of your responses prior to leaving the online Scorecard, as you may find it useful as a reference when interpreting your score or completing the Scorecard in the future.

Tools

Once you have gathered your answers using the PDF version of the Scorecard, you are ready to go through the questions online and submit your responses. If there are questions you cannot answer, simply skip this question. Of course you will not score points on any skipped question.

Select the appropriate link below to enter the online Scorecard and submit your responses.

Take the HERO Scorecard - U.S. version
Take the HERO Scorecard - International version

Tools

Once you have submitted your answers, your scores will be automatically calculated and sent to the email address you entered.

Tools

After you submit your data to the online Scorecard, you will receive a score for each of the six sections and an overall score. While the scoring system is based on a maximum number of 200 points, the highest score attained on the latest benchmarking analysis was 180. This was based on completion of the US version of the Scorecard. Information will become available on the International version of the Scorecard once enough responses have been collected to develop a normative database.

We don't anticipate that any program will ever receive the maximum score of 200; a program that includes every possible element of health and well-being program is neither likely nor probably even desirable, since not all scored elements are appropriate for all organizations! Consider your organization's score relative to those of peer organizations or to emulator organizations.

Your individual scores provide a sense of how your program compares to others in the use of evidence-based and expert recommended best practices, and shows where opportunity for improvement exists.

You may also check your scores against the National Average and latest best practice scores.

Tools

Employers can benchmark their programs in greater depth - and against a group of their own peers - through a series of benchmark reports based on employer size, industry and geographic region. These more in-depth reports provide the aggregated responses to each Scorecard question in addition to the average scores.

Benchmark reports for the US version of the Scorecard are currently provided on a quarterly basis through the HERO Scorecard Preferred Providers Program. Organizations that are interested in learning more about the Preferred Providers Program or about the cost to access benchmark reports may contact Jessica Grossmeier at jessica.grossmeier@hero-health.org.

Tools

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To help you achieve the best results with the HERO Scorecard we have provided a brief planning process for your use: Many Scorecard participants have found that one of the key benefits of completing the Scorecard comes from bringing together health and well-being stakeholders from different departments within their organizations to discuss how best to respond to the questions.

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Fredrick County Worksite Wellness Toolkit

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Fredrick County Worksite Wellness Toolkit

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Fredrick County Worksite Wellness Toolkit

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Minnesota Department of Health WorkWell Healthy Minnesota Toolkit

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Brainstorming topics

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Many different CDC resources for workplace health

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CDC Workplace Health Resource Center | Initiatives | Workplace Health Promotion | CDC

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Work@Health® is an employer-based training program. The ultimate aim of the program is to improve the organizational health of participating employers and certified trainers, with an emphasis on strategies to reduce chronic disease and injury risk to employees and an eye to improving overall worker productivity.

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Best Practice Design Principles of Worksite Health - Highlighted

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Lots of information on several different wellness subjects

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What’s the Hard Return on Employee Wellness Programs - Highlighted

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Workplace Health Program Definition and Description

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Workplace Health Program Definition and Description

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Ideas for brainstorm and future projects

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Workplace Health Program Definition and Description - Highlighted

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Definition of Best Practices in Worksite Wellness - Morgan Perry

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Definition of Best Practices in Worksite Wellness - Morgan Perry

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Best practices within worksite wellness should have a focus on the overall health of the employee and not just financial gain for the organization. According to the CDC, these programs should be comprehensive with different health promotion strategies such as programs, policies, benefits, environmental support, and links that encourage the health and safety of all employees (Workplace health program definition and description, n.d). There should not just be a focus on physical health and the consequences of physical health, as humans are much more complex than that. This is why programs and practices of the programs must be comprehensive for individuals specific needs while focusing on whole person health. Robinson (2013) states this importance of different areas of wellness by discussing a focus on career, social, financial, physical, and community well-being when it comes to essential elements of wellness. A focus on the whole person and considering that poor health can come from a number of factors is an important element to remember when thinking of best practices within worksite wellness.

References
Workplace health program definition and description. Retrieved from https://www.cdc.gov/workplacehealthpromotion/pdf/workplace-health-program-definition-and-description.pdf

Robinson, J. (2013, March 19). How to create a culture of organizational wellbeing. Business Journal. Retreived from http://news.gallup.com/businessjournal/159080/create-culture-organizational-wellbeing.aspx