The following section explores barriers and opportunities for implementing wellness programs.

Employers may have several reasons for being reluctant to initiate workplace wellness programs. Among these is notion that these programs are a form of unwelcome interference in employees’ private lives, including their health habits and medical decisions.1 Some employers consider these programs luxuries that do not contribute to the company’s business goals.1 Yet, others fear that such programs will cost too much or may actually reduce productivity by distracting employees from their work, while other employers believe that their employees will not participate.1 The 2004 National Worksite Health Promotion Survey included a nationally representative sample of US workplaces drawn from the Dun & Bradstreet database.2 A total of 1553 interviews were conducted with workplaces of various sizes and industries, yielding a sample size of 730 workplaces.2 Lack of employee interest was the most commonly cited barrier to implementation of a workplace wellness program, followed by lack of staff resources, lack of funding, low participation by high-risk employees, and lack of support from management.2 There were a greater number of perceived barriers cited in this survey than in a nearly identical survey administered in 1999.2 References Goetzel RZ, Ozminkowski RJ. The health and cost benefits of work site health-promotion programs. Annu Rev Public Health. 2008;29:303-323. Linnan L, Bowling M, Childress J, et al. Results of the 2004 National Worksite Health Promotion Survey. Am J Public Health. 2008;98(8):1503-1509.

The following were found to be employer barriers: When demonstrating the benefits of initiating a workplace wellness program to an employer, it is important to include not only the direct medical cost savings but also the benefit to the company of optimal employee productivity. Productivity on the job may be enhanced by employee good health and satisfaction with an employer who sponsors a wellness program.1 Having an advocate in senior management is also important to successfully implement a wellness program.2 A team approach should be employed or an internal champion selected to generate interest and participation in the program. In addition, providing real-world examples of program benefits, such as the case studies discussed later in this slide deck, provide a strong rationale for implementing a workplace wellness program. The following were found to be employee barriers: Employees may be reluctant to participate in wellness programs at work if they are required to join by adding their names to a public signup sheet that might reveal facts to their colleagues that they would prefer keeping private, such as the presence of depression.3 Similarly, employees may be concerned that revealing a chronic condition may cause stigma or result in discrimination (eg, deprive them of opportunities for promotion) because management might suspect that they would not be up to the task.3 Employees may also have the impression that a workplace wellness program is not worth the trouble of rearranging schedules or changing locations, or they may feel that they just do not have the extra time to spend.4 Perhaps the practice most likely to foster participation in a workplace wellness program is creating and maintaining a “culture of health” in the workplace. This provides a context into which a wellness program fits logically.2,5 Creating a culture of health involves providing choices in many sectors of the workplace, including subsidizing healthy diet choices where applicable, maintaining a smoke-free environment, encouraging physical activity, providing escape from stress, allowing employees time to participate in wellness programs, and making facilities accessible.5,6 References Nicholson S, Pauly MV, Polsky D, et al. How to present the business case for healthcare quality to employers. Appl Health Econ Health Policy. 2005;4(4):209-218. Serxner S, Anderson DR, Gold D. Building program participation: strategies for recruitment and retention in workplace health promotion programs. Am J Health Promot. 2004;18(4):1-6. Entrepreneur. Wellness programs. http://www.entrepreneur.com/encyclopedia/term/82650.html. Accessed November 4, 2010. Person AL, Colby SE, Bulova JA, Eubanks JW. Barriers to participation in a workplace wellness program. Nutr Res Pract. 2010;4(2):149-154. Goetzel RZ, Ozminkowski RJ. The health and cost benefits of work site health-promotion programs. Annu Rev Public Health. 2008;29:303-323. McPeck W, Ryan M, Chapman LS. Bringing wellness to the small employer. Am J Health Promot. 2009;23(15):1-10.

There are various effective tools and incentives to drive interest in a wellness program. For example, one way to encourage participation in wellness programs is to provide employees with some type of incentive to join. Incentives can include tokens such as inscribed mugs, caps, mouse pads, or a lottery awarding a prize such as a CD player.1 Incentives can also take the form of cash bonuses or reductions in employees’ share of health insurance premiums or copays.1 A membership in a fitness club, which may be covered at least in part by insurance, is another particularly relevant incentive.2 References Serxner S, Anderson DR, Gold D. Building program participation: strategies for recruitment and retention in workplace health promotion programs. Am J Health Promot. 2004;18(4):1-6. McPeck W, Ryan M, Chapman LS. Bringing wellness to the small employer. Am J Health Promot. 2009;23(15):1-10.

As you’ll see, there are different ways to assess the return on investment of these programs.

The narrowest measure of ROI is financial savings that exceed the cost of the program.1 Other measures, however, contribute to the overall success of a workplace wellness program, including reduced absenteeism and presenteeism and improved employee health.1 The diagram shown here is one example of a longitudinal framework for measuring all aspects of ROI for a workplace wellness program.2 References Serxner S, Gold D, Meraz A, Gray A. Do employee health management programs work? Am J Health Promot. 2009;23(4):1-8. Grossmeier J, Terry PE, Cipriotti A, Burtaine JE. Best practices in evaluating workplace health promotion programs. Am J Health Promot. 2010;24(3):TAHP-1–TAHP-9.

The obvious components of ROI for employers are financial savings and increased worker productivity in the form of reduced absenteeism and presenteeism. However, employers may reap less quantifiable rewards. Employee turnover can likely be decreased in a company perceived to care about its employees and/or to offer added value. Although goodwill cannot be quantified, loyalty and consistency are promoted by that perception, and employees are more likely to remain employees and work productively for a company that contributes to enhanced morale. Reference Nicholson S, Pauly MV, Polsky D, et al. How to present the business case for healthcare quality to employers. Appl Health Econ Health Policy. 2005;4(4):209-218.

Numerous studies attest to the positive ROI of wellness programs Numerous studies attest to the positive ROI of wellness programs. Baicker and colleagues conducted a meta-analysis of the literature on the ROI of workplace wellness programs.1 Across reports of 36 rigorous, well-designed studies, they found a large positive ROI for these programs.1 Average ROI across studies was calculated as amount saved for every dollar spent.1 For studies focusing on healthcare costs, the average ROI was $3.27, and for those examining absenteeism, it was $2.73.1 Many employers may be skeptical about the benefits of wellness programs because they may not see an immediate return on their investment or they may believe that the methodologies used to measure program success are not rigorous or lack transparency. However, as the study on the next slide demonstrates, a long-term commitment to wellness programs by employers is necessary before a positive return on investment can be garnered.2 References Baicker K, Cutler D, Song Z. Workplace wellness programs can generate savings. Health Aff (Millwood). 2010;29(2):304-311. Serxner S, Gold D, Meraz A, Gray A. Do employee health management programs work? Am J Health Promot. 2009;23(4):1-8.

Maintaining a long-term commitment is key to success Maintaining a long-term commitment is key to success. ROI may not be positive in the first year of a workplace wellness program, during which the costs to set up, initiate, and publicize the program may outweigh the benefits.1 However, as the chart depicts, the ROI increases with advancing duration of the program, suggesting that workplace wellness should be considered a long-term investment.1 Exercise programs provide an instructive example, as many people who attempt to incorporate them into their routine have to be motivated to change their lifestyle and make a long-term commitment for them to be successful. Similarly, exercise or other health and wellness programs implemented by an employer may require a shift in culture in the workplace to accommodate these initiatives.2 References Serxner S, Gold D, Meraz A, Gray A. Do employee health management programs work? Am J Health Promot. 2009;23(4):1-8. Serxner S, Anderson DR, Gold D. Building program participation: strategies for recruitment and retention in workplace health promotion programs. Am J Health Promot. 2004;18(4):1-6.

Employees who participate in workplace wellness programs reap some less tangible benefits in addition to the incentives they may receive for joining. With cardiovascular disease remaining the primary cause of death in the United States, increased understanding of the risk factors and learning methods for minimizing these factors can yield a lifelong benefit for workers.1 Along with the health benefits of these programs, they may enhance employee morale and potentially improve productivity.2 References Byrd K, Silliman K, Morris MN. Impact of a three-year workplace wellness program on employee blood lipid levels. Californian J Health Promot. 2008;6(1):49-56. Zank D, Friedsam D. Employee health promotion programs: what is the return on investment? Issue Brief. 2005;6(5):1-2. http://www.pophealthwisc.edu/uwphi. Accessed September 11, 2010.

The benefits of wellness programs may be far-reaching The benefits of wellness programs may be far-reaching. Workplace wellness programs provide benefits to employers not only through reduced healthcare costs but through other benefits as well. As the chart demonstrates, workplace wellness programs increase employee morale and improve employee health and productivity. These improvements can potentially result in reduced accidents while on the job and reduced absenteeism.   Reference OSHA Website. http://www.osha.gov/dcsp/smallbusiness/forums/aging_presentation/slide79.html. Accessed November 4, 2010.