Posts from — January 2009

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 needed 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 Worksite Wellness Plan resources, first determine the resources you need and the resources you have. Then develop a plan to fill the resource gaps.

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

Establish available Worksite Wellness Plan resources.
• Use materials that exist or are already on hand. Resist the temptation to start from scratch!
• Determine what other departments already have.
• 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 Worksite Wellness Plan resource gaps.
• Partner with as many staff members and businesses as you can. Stress 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 Worksite Wellness Plan 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 Worksite Wellness Plan 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 Workplace Wellness Programs directly started at the unit level.
• Get to know the contracting person at your company. They frequently know the least expensive places to obtain many different types of materials.
• Look for “recycling” possibilities.
o Example: You 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 Workplace 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 Workplace 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. By way of example, scheduling appointments is a company process that results in an orderly work flow and timely patient care.

Worksite Wellness Plan implementation frequently requires changes to established company 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 Worksite Wellness Plan will be coded.

Not all change can be affected painlessly. However, developing a plan for achieving change will overcome obstacles 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 company process.
• By way of example: what is the current registration process for the weight management program? Include steps for both members and staff.

Establish where the new or modified company process could fit into the current process.
• By way of 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 By way of 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 staff members as you can – including those that might be most resistant to the change.

Communicate.
• Don’t keep the change a secret. The more staff members know, the more likely they will support a change.
• Anticipate obstacles 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.

Worksite Wellness Plan evaluation is critical for effective Wellness and will help you get Upper Management support.

Why evaluate your Workplace Wellness Program?

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

Worksite Wellness Plan Fact of Life:

Worksite Wellness Plan evaluation left to “chance” or until “there is time” will never happen.

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

Where do you start?

Make it Simple. Worksite Wellness Plan evaluation does not have to be complicated.
• Get baseline information.
• Baseline information is the health status of the target population at the beginning of the Workplace Wellness Program.
• Start 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 information.
• 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 information that relates to readiness.
• You should always be ready to communicate to leadership the ways that your Worksite Wellness Plan impacts readiness. Plan ahead to collect information that will demonstrate this connection.
• Think like Upper Management: what Worksite Wellness Plan outcomes will be important from Upper Management point of view?

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

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

Think ahead: what unexpected challenges might come up as you begin your Workplace Wellness Program? How could you adapt and change the Worksite Wellness Plan to meet those challenges?

• Look at the “what if’s?”
• What if your classroom space is suddenly no longer available?
• What if you can’t hold the Wellness Fair in the usual place?
• Have a ‘Plan B’ (or even Plan C or Plan D) in mind for when the “what if’s” happen.

• Build a team that can help with the Worksite Wellness Plan
• Who else could teach the health education class if the regular instructor cancels at the last minute?
• Know what areas of expertise your staff has besides their ‘main’ job. By way of example, find out who has fitness instructor credentials besides just the physical therapist.
• Don’t wait for a crisis before you build a network of staff members that you can call on.

• Be ready to roll your sleeves up
• Jump in to fill a gap if you need to.
• YOU may have to help restock the milk case in the dining facility when the Dairy Month ‘Milk Mustache’ contest results in raised sales during lunch.

• Be willing (and ready) to respond to feedback about the Worksite Wellness Plan
• Get participant feedback while the Worksite Wellness Plan is ongoing. Then be ready to adapt to those suggestions.
• By way of example, if kids in a pediatric obesity Worksite Wellness Plan fight the idea of completing exercise logs, then get a verbal summary of their activity for the week instead.

• Simplify Worksite Wellness Plan
• If part of your Worksite Wellness Plan is not working, try making that part less complicated.
• By way of example, if getting follow-up information is not going the way you planned, then make the process to get information easier OR decrease the number of pieces of information that you collect.

• Use lemons to make lemonade
• What do you do when the Worksite Wellness Plan doesn’t turn out exactly as you planned? Look for what did turn out. Often, the ‘unexpected outcomes’ produce positive results.
• By way of example, one company’s database to collect sick call data was made obsolete by a regional system. However, the company database was able to be used in a different way to track vaccination information that improved delivery of care to Employees.

Take the time to plan Workplace Wellness Programs before they are started.

Strategic planning enables better use of all your resources. Include all the steps below when you plan a Wellness activity.
• Do your homework – Identify the science and research that support your interventions. Look for similar Workplace Wellness Programs that already exist.
• Determine the specific health need(s) – Use these needs to target interventions to problems that are an issue for your population.
• Organize a team – A team is a resource multiplier. Network and build as many partnerships as you can.
• Make a plan, but don’t start completely from scratch. Make a written plan for your Workplace Wellness Program. Look for every opportunity to take advantage of resources that already exist. Don’t reinvent the wheel.
• Select a focus – Choose one or two main target areas for Workplace Wellness Programs. Address all five stages of change in the target areas rather than trying to hit every possible Wellness topic.
• Determine your resources – What assets do you have? What assets will you need? How can you fill the gaps?
• Get Upper Management support – Think like Upper Management. Communicate the value of Wellness from Upper Management’s perspective.
• Start the activity- Be flexible. Be prepared for unexpected challenges.
• Market the activity – Keep your Worksite Wellness Plan visible for Upper Management, line and medical personnel, Worksite Wellness Plan members, and potential partners and volunteers.
• Collect and analyze outcomes – Outcomes indicate Worksite Wellness Plan impact. Start with just a few outcomes – you don’t have to collect everything. Remember that it’s never too late to start measuring Worksite Wellness Plan impact.
• Evaluate, improve and re-evaluate – Use participant feedback and Worksite Wellness Plan outcomes to determine Worksite Wellness Plan impact. Establish areas in need of improvement. Use outcomes to determine if expended resources were worth the results.

Why use small steps toward behavior change?

Small steps give members immediate feedback on the changes they make towards better health. Measuring these small steps is also an excellent way to collect interim Worksite Wellness Plan effectiveness information.

Worksite Wellness Plan small steps make a big difference

Small steps for Worksite Wellness Plan members
• Walk to work.
• Use fat free milk instead of whole milk.
• Each day think of two things you are grateful for.
• Do sit-ups while you watch TV.
• Drink water before a meal.
• Take 10 deep breaths to relieve tension.
• Eat half your dessert.
• Skip second helpings and buffets.

Measuring small Worksite Wellness Plan steps
• Use short pre- and mid-point surveys to ask:
• How many glasses of water do you drink a day?
• How frequently you do eat fast food?
• How frequently do you skip a meal?
• How frequently do you engage in physical activity?
• How many servings of fruits and vegetables do you eat each day?

Use the results to show members how their health behaviors are changing for the better.

• Ask members to rate their health status and/or stress levels before and after an intervention.
• Add up individual (or team) steps and mark the progress on a map towards a far away destination.
• Be creative! Do not rely only on weight loss, BMI, or cholesterol tests as health status progress indicators or behavior change feedback.

Wise words for taking small Worksite Wellness Plan steps

• The first wealth is health. (Ralph Waldo Emerson)
• We are what we repeatedly do. (Aristotle)
• The victory is not always to the swift, but to those who keep moving. (CDC)
• There are 1440 minutes in every day…schedule 30 of them for physical activity. (CDC)

Why Worksite Wellness Plan follow up?

Getting feedback from Worksite Wellness Plan members serves two purposes: to obtain information that quantifies a Wellness Program’s impact, and to find ways to improve a Workplace Wellness Program.

Building follow up into your Worksite Wellness Plan

Make it Simple
• Keep follow up to information you absolutely require. A three-question survey is more likely to get a response than one with 20 questions.
• Use email or phone for follow-up. Use personal and business email addresses; use cell phone and unit phone numbers.
• Go to the Employees: go to the unit or somewhere else they will all be gathered, and get follow up information there.
• Give members a stamped envelope addressed to you, with a printed form listing the information you will need.

Keep it structured
• Tell members right from the beginning that you will be doing follow up after the Worksite Wellness Plan is finished. Be specific about the information you will collect.
• If you need to do hands-on measurements, find out if members will be coming back to your location for another reason (like another clinic appointment). Ask them to stop by while they are in the building – or, better yet, go to where they will be.
• Ask members where they will be the next time you will be collecting information. They may already know their next duty station if they will be PCSing soon.
• Plan ahead for follow up and put it on the schedule. Planning to do follow up “when you have time” usually means follow up will never get done.

Keep it catchy
• Give members something to go along with the request for information. By way of example, if you send an email to ask for information, send along a yummy recipe or a timely fitness tip.
• Schedule a ‘reunion’ day to collect follow up information. Invite members to come back and share successes and challenges. Have some (healthy) munchies available.
• Have a silly contest – the team with the most follow up information wins something, like having their photos posted on a prominently-placed bulletin board or an eggplant trophy, or some other fun thing.

Why bother to market your Workplace Wellness Programs?
Because of the transient nature of the many worker populations, you must market your Workplace Wellness Programs all the time. Your goal should be to keep your Workplace Wellness Programs as visible as possible.

Innovative marketing can increase awareness of your Worksite Wellness Plan for:
• Potential Worksite Wellness Plan members
• Upper Management
• Line and medical personnel
• Potential partners and volunteers

Innovative Worksite Wellness Plan marketing ideas

Involve Upper Management in your marketing Worksite Wellness Plan as frequently as possible.
• By way of example: invite Upper Management to judge a Worksite Wellness Plan logo contest.

Link your Workplace Wellness Programs to national advertising campaigns
• …like the Great American Smokeout and the Dairy Council’s Milk Mustache campaign.

Collaborate closely with personnel in the home office.
• Submit articles about your Workplace Wellness Programs that coincide with National Health Observances. By way of example: highlight your Asthma Program in May, which is National Asthma Awareness Month.
• Let the home office know you can always provide an article to them when they run short on material. (Then make sure you always follow through.)
Word of mouth is the most effective advertising for your Worksite Wellness Plan
• Use real staff members in your advertising: enlist the help of successful Worksite Wellness Plan members or use Employees and other post personnel for your marketing materials, when possible.
• Start “buzz” by incorporating an element of competition: which ‘team’ had the most steps over the past week? Which department engaged most frequently in physical activity?
Take advantage of technology
• Use post television and radio resources.
• Use email whenever you can.
Don’t simply market your Worksite Wellness Plan to potential members, but market the opportunities for others to be involved, as well.
• By way of example: does the Red Cross know you can always use a volunteer? Do other departments/clinics know that you can always use personnel with some temporary down time?
Don’t be “old news”
• If you put advertising materials up, be sure to take them down in a timely manner.
• Update marketing logos and themes as appropriate.

What is Worksite Wellness Plan data?

Worksite Wellness Plan data is information that is collected about your Workplace Wellness Program. All Workplace Wellness Programs should include data as an integral part of the Worksite Wellness Plan plan.

Why should you care about Worksite Wellness Plan data?

Data tells the Wellness story. Data is the tangible evidence of a Wellness Program’s impact.

Building data into Workplace Wellness Programs

Why bother with Worksite Wellness Plan Data?

You need Worksite Wellness Plan data to:
• Evaluate whether or not your Worksite Wellness Plan is working.
• Answer the ‘so what?’ about the need for a Workplace Wellness Program.
• Offer information to Upper Management about the impact of the Workplace Wellness Program.
• Write a budget justification so you can secure Worksite Wellness Plan resources.
• Use Worksite Wellness Plan resources efficiently and market your Worksite Wellness Plan more effectively.

Where to begin collecting Worksite Wellness Plan data:
• MAKE A PLAN to collect the data: decide what, when, and how information will be collected.
• Determine what information is ALREADY BEING COLLECTED.
o By way of example: use dairy sales information in the dining facility to measure the impact of a milk marketing/dairy month campaign.
• Start collecting JUST A FEW small pieces of information. Be creative!
o By way of example: BMI, APFT scores (before & after), tobacco quit rates

IT’S NEVER TO LATE TO START collecting Worksite Wellness Plan data.

Innovative Worksite Wellness Plan data strategies
• Use local college/graduate students to help collect, input, and analyze Worksite Wellness Plan information.
• If your company has an internship program, get to know the Internship Director. Take advantage of intern resources – including having the Director and/or interns begin the data collection plan for your Workplace Wellness Program.
• Use information to let upper management know about the Workplace Wellness Programs affect on the staff members.

Present this information at their monthly/quarterly meetings.
• Use creative follow-up strategies to get information. Phone calls can be effective, but also consider email, mailed surveys with return postage provided, and going to the units in person to collect the information.
• Make data collection ‘fun’ for Worksite Wellness Plan members.
o By way of example: use a team approach – the team with the ‘best’ overall results gets some sort of award or recognition.
• ALWAYS relate the impact of your Worksite Wellness Plan to readiness.