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Employee Health and Wellness Program communication is important to all aspects of Wellness and preventive medicine and is relevant to:
• Healthcare provider-patient relationships
• An individual’s exposure to, search for, and use of Employee Health and Wellness Program information
• Effective counseling and patient education for behavior change
• Content of public health messages and community campaigns

Effective health communication should have these attributes:
• Accuracy: content is valid and error-free
• Availability: delivered or placed where the intended audience can access the information
• Balance: content presents benefits and risks of potential actions
• Consistency: content is locally consistent over time and is also consistent with information from other reliable sources
• Evidence-based: content and methods of delivery are based on relevant scientific evidence
• Reach: content gets to or is available to as many individuals as possible in the target population
• Reliability: content source is credible; content is kept up-to-date
• Repetition: delivery of/access to the content is continued over time, to reinforce the impact with the audience and to reach new members of the target population
• Timeliness: content is provided when the audience is most receptive to, or in need of, the specific information
• Understandability: reading, language levels, and format are appropriate for the specific audience (i.e., Employees, Family Members, Garrison leadership, etc.)

What the research says about health communication
• Health communication best supports Wellness when multiple communication methods are used to reach specific audiences.
• Effective Wellness and communication initiatives should reflect an audiencecentered perspective, and reflect the preferred formats, contexts, and method of communication for the intended audience.

Material adapted from: U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000.
http://www.healthypeople.gov/document/HTML/Volume1/11HealthCom.htm

Evaluation of successful Employee Health and Wellness Programs has revealed several primary Employee Health and Wellness Program strategies to increase Employee Health and Wellness Program effectiveness and impact overall Soldier health.

Strategy #5: Using a small number of targeted priorities maintains Employee Health and Wellness Program focus.

• Needs assessment data can be used to identify leading health needs and also high risk populations.
• Choosing a handful of specific health needs on which to focus will maximize efficient use of resources.
• Keeping the Employee Health and Wellness Program focus small will avoid duplication of other ongoing installation Employee Health and Wellness Programs.

Strategy #6: Use standardized processes whenever possible.

Reduce the amount of variation within your Employee Health and Wellness Programs by standardizing all the processes needed for Employee Health and Wellness Program planning and implementation. For example:
• Use the same spreadsheet format for data collection so that the columns are in the same order. This way you can compare data more easily.
• Reuse the same forms for enrollment and attendance. Change the heading as needed.
• Look at other Wellness Programming processes (like registration, evaluation, marketing, etc.). What parts of those processes can be standardized?
• The Wellness and Prevention Initiatives website (http://chppmwww. apgea.army.mil/dhpw/Population/HPPiFunction.aspx) has many standardized Employee Health and Wellness Program resources in a variety of topic areas.

Strategy #7: Employee Health and Wellness Program delivery methods should be flexible and adapted to population needs.

• Delivery of products and services may depend on: unit needs, training requirements, other scheduling considerations (such as work/duty schedules, school scheduling, etc.), participant preference, and/or availability of staff or space.
• Be flexible: the same produce/service delivery methods may not work for every population.
• Some units may want services provided to them as close as possible to the unit location; other units may prefer as many services as possible bundled together at once (regardless of location).
• Take Wellness and preventive medicine beyond the walls of the business in order to meet leadership and worker needs. Answer the question: “How can we best help leadership and Employees to fulfill their mission?”

Evaluation of successful Employee Health and Wellness Programs has revealed several primary Employee Health and Wellness Program strategies to increase Employee Health and Wellness Program effectiveness and impact overall Soldier health.

Strategy #1: Communication with leadership is essential

• Assess leadership priorities.
• Report Employee Health and Wellness Program outcomes back to leadership in a timely manner.
• Equal investments of support from both the medical and line community will result in enhanced Employee Health and Wellness Program success.

Strategy #2: Employee Health and Wellness Program planning must be driven by data.

• Determine specific needs of the target population.
• Focus on the health status of the population as a whole to identify the top health concerns.
• Information should drive decisions regarding which health needs should be addressed first.

Strategy #3: Use electronic data collection and reporting as frequently as possible.

• Centrally collected data in an electronic format is essential for determining population health needs.
• Electronic reporting is also very valuable when communicating Employee Health and Wellness Program outcomes to leadership and other stakeholders.
• Flexible reporting capabilities allow data to be presented as information that can support decision-making, in formats that decision-makers prefer.

Strategy #4: Multidisciplinary collaboration enhances worker health and maximizes available resources.

• Collaboration between health disciplines increases effectiveness of Wellness and preventive medicine initiatives.
• Don’t forget to look outside the business for collaboration partners.
• Optimized Employee Health and Wellness Program outcomes can be met by coordinating the activities of medical consultants, cadre, community agents, and funding sources.
• Bundling services together also provides the additional benefit to units by conserving training and mission time.
Implementing these strategies can improve Employee Health and Wellness Program effectiveness and optimize available resources.

Changing health-related behaviors is a difficult challenge. Incorporate the tools below into your Wellness initiatives to assist members in successfully changing health behaviors.

Tool #1: Establish effective goals

• Focus on areas that can impact the overall goal.
• For example, if the overall goal is to lose weight, the most productive areas to focus on are the dietary and activity changes that will lead to long-term weight loss.
• For example, stress management and improving self-esteem may also impact weight loss; however, improving relationships, while a worthwhile topic, will not necessarily impact weight loss.
• Make the goals specific, attainable, and forgiving. For example:
• “Exercise more” is too general.
• “Walk five miles everyday” is specific, but may not be attainable.
• “Walk 30 minutes everyday” is specific and more attainable, but is not very flexible.
• “Walk 30 minutes, five days a week” is specific, attainable, and forgiving.
• Use a series of short-term goals to achieve the ultimate goal.
• Short-term goals break big challenges into more easily attained pieces.
• Smaller steps also provide Employee Health and Wellness Program members with encouragement and success. These small successes are essential for maintaining motivation towards a long-term goal.

Tool #2: Increase self-awareness

• Self-monitoring is useful for tracking behavioral and environmental cues that trigger a particular health behavior.
• Keeping track of health behavior status is also useful for times when progress towards a goal is difficult to measure, or when an individual is in a maintenance stage.

Tool #3: Provide rewards and motivation

• Encourage members to reward themselves for achieving small successes on the way to their ultimate goal.
• Remember that rewards don’t always have to be “things.” Words of encouragement and praise can provide powerful motivation when spoken by a teacher, instructor, parent, friend, etc.

Tool #4: Respond effectively to set-backs

• health behavior change is conceptually a continuum. However, movement along that continuum is not just in one direction. Employees can move backwards or forwards or sometimes just stay put. Communicate to members that set-backs, lapses and even staying the same (i.e., maintenance) are common for individuals trying to change behavior.
• Stress is frequently a factor in lapses and relapses. Provide a variety of stress management resources to help members better handle the stress which could trigger a set-back.
• Brain storm to create a list of potential (and probable) barriers to participant behavior change. Then formulate strategies to meet each of those challenges.
• Improved time management and decision-making skills can be effective ways to overcome behavior change relapses.
• Provide members with information regarding the behavior change process so that they will be better prepared for the challenges they will face. A brief overview of the Stages of Change may be helpful.

Most companies do not have the Employee Health and Wellness Program resources to address all of their health needs at once. Priorities must be set to determine the most pressing health needs. Use the steps below to prioritize installation Wellness needs.

Assess the health needs of the population.

Collect data about the health needs in the community. How?

• Community- or target group-specific surveys

Identify health needs and at-risk populations.

Use the data to identify leading health needs and also high risk populations. For example:
• Obesity and overweight
• Injury prevention
• Self care

Reduce the list.

Not every health need can (or should) be addressed. Use the following questions to determine which health needs should be addressed first.
• How does the health need impact operational readiness? How big is the impact?
• What are the Senior Management priorities? How does the health need fit into those priorities?
• What are the behavioral factors affecting the health need? What is the evidence that a behavior change will make a difference? Has the behavior been successfully changed by other Employee Health and Wellness Programs?
• What other physical, social, or environmental factors influence the health need or the target population?
• Is the health need a greater problem at the local level than in the U.S. population as a whole?
• Does the business have the subject matter expertise and resources to address the health need?

Develop Employee Health and Wellness Program recommendations.

Only a handful of specific health needs should be focused on in a given year. Keep the following in mind as recommendations are developed as to which specific health needs will be addressed:
• Avoid duplication of other ongoing Employee Health and Wellness Programs whenever possible. Identify Employee Health and Wellness Programs already addressing the health need and/or the target population.
• Identify and assess available resources. Build on existing services whenever possible.

Use the recommendations to offer tailored, targeted, integrated initiatives to address the prioritized list of health needs. Prioritizing health needs will keep Employee Health and Wellness Programs focused, maximize efficient use of resources, and align Wellness efforts with Senior Management goals and priorities.

References
• US Department of Health and Human Services, Planned Approach to Community Health, http://www.cdc.gov/nccdphp/publications/PATCH/index.htm.
• Implementing a Comprehensive Community Wellness and Well Being Program, presentation by CHPPM-EUR at the 2006 Force Health Protection Conference

Keeping the bottom line up front Bottom Line Up Front in Employee Health and Wellness Program will help you get and sustain Senior Management support. A Bottom Line Up Front approach will also help you more realistically measure the impact of your Employee Health and Wellness Program.

The bottom line in Employee Health and Wellness Programs answer two primary questions:
• How will participant health be improved?
• What’s in it for Senior Management?

The ultimate bottom line: all roads should lead to readiness.
• Always be ready to communicate to leadership the ways that your Employee Health and Wellness Program impacts readiness.
• Think like Senior Management: what Employee Health and Wellness Program outcomes will be important from a Senior Management point of view?
• Develop line-centered language that communicates those outcomes.
• Ask members how they think a particular Employee Health and Wellness Program enhances force readiness. This input is a valuable source of information.

Use the following steps as a Bottom Line Up Front approach to Employee Health and Wellness Programs.

Step 1: Think about the end of the Employee Health and Wellness Program first and plan backwards.
• It has been said, “If you don’t know where you’re going, any road will get you there.”
• Before planning or implementing any part of the Employee Health and Wellness Program, be able to answer the questions: how will participant health be improved? What’s in it for Senior Management?

Step 2: Identify concrete Employee Health and Wellness Program outcomes.
• Identify up front what the Employee Health and Wellness Program is working towards.
o For example: will members lose weight? Walk more steps? Decrease injuries? Move to another stage of change?
• Identify any processes or procedures that will be improved.
o For example: which pharmacy operations will become more efficient? How will record-keeping be streamlined?

Step 3: Determine what will be measured to show that Employee Health and Wellness Program goals were achieved.
• Look at what data is really needed to show Employee Health and Wellness Program effectiveness. Avoid the temptation to collect every possible piece of data. Choose a handful of important data points and stick to those.
• Think backwards when deciding what data to collect – consider how easily follow-up data can be collected when a Employee Health and Wellness Program ends. Getting follow-up data is frequently a challenge.
• Only collect data for health behaviors or indicators that the Employee Health and Wellness Program actually affected.
o For example: if the main Employee Health and Wellness Program goal is that members will walk more steps, then it may be better NOT to choose changes in cholesterol level as a Employee Health and Wellness Program outcome (unless the Employee Health and Wellness Program specifically addresses cholesterol).
• Avoid measuring outcomes that the Employee Health and Wellness Program cannot (or did not) affect.

Step 4: Determine what Employee Health and Wellness Program elements must be included to move members towards the Employee Health and Wellness Program goals.
• The concrete Employee Health and Wellness Program outcomes identified in Step 2 are the compass for keeping the Employee Health and Wellness Program on track. All Employee Health and Wellness Program elements should lead towards that ultimate goal.

Working backwards when planning and implementing Employee Health and Wellness Programs is really forward thinking. Keeping the bottom line up front is a smart approach to Employee Health and Wellness Programs.

Health Information Technology can make the entire health care system more effective and efficient by enhancing:
• Documentation (lab and test results, clinic notes, consult recommendations)
• Communication (provider to patient, provider to provider)
• Information input (templates to facilitate data entry)
• Delivery of care (documenting all patient-provider interactions in a single system)
• Chronic disease risk identification (evaluation of risk factors, recommendations for appropriate preventive services and screenings)
• Consistent recording of correct billing codes

But, adapting to Health Information Technology is a challenge.
• Health Information Technology almost always involves a “new system.” Consequently, the entire staff, from health care providers to IM/IT personnel is on a learning curve.
• Existing IT infrastructure may not be adequate, so the Health Information Technology system may be very slow, or may frequently crash.
• The new system may not have all the forms you need already in place. New forms may be needed.

Lessons learned from Health Information Technology implementation

Take advantage of as many training opportunities as possible.
• Learn as much as you can about the Health Information Technology that you need to use. Become an expert.
• Ask questions if you are unsure how to navigate the system.

Keep the big picture in mind.
• Be aware that those keeping the Health Information Technology system up and running may have a very different set of priorities. The IM/IT staff may not see your request as a priority when it is taking all their manpower to trouble shoot the new system each day.
• Other changes to the Health Information Technology system may be in line in front of yours, so be patient.

Think through changes thoroughly.
• Take time to think through a new form thoroughly. Know exactly what you want before talking to the developer.
• Don’t think in a vacuum. If you build a form, make sure it is one your staff will use and find efficient.
• Make a draft version of the form and use it before requesting that it be put into the new system.
• Be prepared to build a good case for why your form should be created. Build a stronger case if your form should be developed ahead of other requests in the queue.
• Be patient and persistent when working with a programmer/developer on a new form. Meet frequently and set up timelines and deadlines.
• Coordinate with IM/IT and the Health Information Technology contractor to see if they can support a new project in the required time frame.

For more information about Health Information Technology implementation, go to the Agency for Healthcare Research and Quality (AHRQ) National Resource Center for Health Information Technology at http://healthit.ahrq.gov.

To effectively manage your Employee Health and Wellness Program resources, first determine the resources you need and the resources you have. Then develop a plan to fill the resource gaps.

What Employee Health and Wellness Program resources do you need?
• Make a list of individuals, materials, equipment, space, and logistical support.
• Be as specific as possible.
• Include partnerships that will be needed to make the Employee Health and Wellness Program happen.

Identify available Employee Health and Wellness Program resources.
• Use materials that exist or are already on hand. Resist the temptation to start from scratch!
• Find out what other departments already have.
• Contact DHPW/HPPI to find out what other installations have done.
• Know where to borrow or get free materials.
• Use local or internal resources whenever possible.
• Look for opportunities to cut and/or share costs.

Develop a strategy to fill Employee Health and Wellness Program resource gaps.
• Partner with as many individuals and companies as you can. Emphasize what’s in it for them.
o Example: use a Physical Therapist to teach a back health class.
• Take advantage of community organizations and coalitions.
• Use volunteers as frequently as possible.
o Red Cross volunteers, medical interns or nursing students can supplement your manpower.

Former Employee Health and Wellness Program members make good guest presenters.
• Keep a list of subject matter experts who will provide input for free so you can avoid the expense of an outside contractor or consultant.

Look for creative Employee Health and Wellness Program opportunities.
• Other funding opportunities may exist at your facility.
o Example: if there is a book fair, see if you can apply to receive some of the proceeds.
• Ask the unit to contribute resources to Employee Health and Wellness Programs directly started at the unit level.
• Get to know the contracting person at your installation. They frequently know the least expensive places to obtain many different kinds of materials.
• Look for “recycling” possibilities.
o Example: IMD may be able to give you old computer workstations for use with electronic health assessments.

Good communication will help you find more partners and volunteers.
• Get the word out to the community about your Employee Health and Wellness Programs.
• Describe what you are doing and how you are doing it.
• Presentation is everything. Keep information current and use lots of visual aids.

All Employee Health and Wellness Programs require resources. Some resources you will already have. Some resources you will have to find. Sometimes you will have to make something out of very little. Smart strategies can maximize your Wellness resources.

Business processes are structured activities that achieve a specific result. For example, scheduling appointments is a business process that results in an orderly work flow and timely patient care.

Employee Health and Wellness Program implementation frequently requires changes to established business processes. These changes may be simple, such as adding prescreening appointments to the scheduling process, or more complicated, like determining how time devoted to a particular Employee Health and Wellness Program will be coded.

Not all change can be affected painlessly. However, developing a plan for achieving change will overcome barriers like:

“But we’ve always done it that way” or “But we’ve never done it that way.”

Each change situation will be different. The path to achieving change may not always be straightforward.

Lesson learned: Making small, incremental changes will be easier than trying to make one big change. It is also easier to modify a current process than to introduce a brand new one.

Develop a road map for change.

Describe the current business process.
• For example: what is the current registration process for the weight management program? Include steps for both members and staff.

Identify where the new or modified business process could fit into the current process.
• For example, prescreening appointments for the weight management program could be scheduled when members sign up OR the prescreening could be done at the first class.

Collaborate.
• Look at the change process to be a team effort. Determine everyone who will be affected by the change and get their input.
o For example, be sure to ask the personnel that set up the prescreening appointments AND the personnel that would do the prescreening for their ideas.
• Recruit one or more champions for the change. It helps if the champion has some clout.
• Get buy-in from as many individuals as you can – including those that might be most resistant to the change.

Communicate.
• Don’t keep the change a secret. The more individuals know, the more likely they will support a change.
• Anticipate barriers ahead of time. Be ready to articulate concrete benefits that will result from the change – especially advantages such as costs avoided or training time conserved.

Employee Health and Wellness Program evaluation is critical for effective Wellness and will help you get Senior Management support.

Why evaluate your Employee Health and Wellness Program?

Employee Health and Wellness Program evaluation answers these questions:
• What change(s) occurred in the target population?
• ‘What’s in it’ for Senior Management?
• Are the resources that are being used worth the outcomes that are reached?
• Were Employee Health and Wellness Program outcomes expected? (Unexpected outcomes may have occurred.)
• What Employee Health and Wellness Program areas need improvement?

Employee Health and Wellness Program Fact of Life:

Employee Health and Wellness Program evaluation left to “chance” or until “there is time” will never happen.

• Employee Health and Wellness Program evaluation should be considered as an essential part of the whole plan for Wellness and not as something extra.

Where do you start?

Keep it simple. Employee Health and Wellness Program evaluation does not have to be complicated.
• Get baseline data.
• Baseline data is the health status of the target population at the beginning of the Employee Health and Wellness Program.
• Begin by collecting just 3 or 4 primary items as the baseline. You will have better success collecting follow-up information later if you only need to get a few pieces of data.
• Don’t rely only on health indicators that require lab evaluation. Also use self-report information and health indicators that are measurable without lab tests.

• Collect data that relates to readiness.
• You should always be ready to communicate to leadership the ways that your Employee Health and Wellness Program impacts readiness. Plan ahead to collect data that will demonstrate this connection.
• Think like Senior Management: what Employee Health and Wellness Program outcomes will be important from Senior Management point of view?

• It’s never too late to incorporate Employee Health and Wellness Program evaluation into Employee Health and Wellness Programs.
• If your Employee Health and Wellness Program is already up and running and you didn’t plan for data collection ahead of time, start collecting data NOW.
• If you don’t have baseline data, then collect interim data and compare that to end-of-program data.
• Or, you can compare final Employee Health and Wellness Program outcomes to similar programs elsewhere.

If you can’t make any comparisons to other data, use resources like The Community Guide (http://www.thecommunityguide.org/ ) that have already evaluated the effectiveness of Employee Health and Wellness Program components. Compare the components of your Employee Health and Wellness Program to those that have been proven effective elsewhere.