Healthy Workers William Baun, EPD, CWP, FAWHP

Wellness Officer MD Anderson Cancer Center

Healthy Health Systems Leonard Berry, PhD

University Distinguished Professor of Marketing Mays Business School Texas A&M University

2014 HealthSmart Forum

Our Agenda Today

Keeping People Healthy (Bill)

Delivering More Efficient and Effective Healthcare When They Do Get Sick (Len)

William B. Baun, EPD, CWP, FAWHP Wellness Officer, MD Anderson Cancer Center

President, National Wellness Institute wbaun@mdandeson.org/

Healthy Worker Business Sustainability

Strategy William B. Baun, EPD, FAWHP

Wellness Officer wbaun@mdanderson.org williambaun.blogspot.com

• Older • More stressed out • Sicker • Fatter

Global Workers

PATHWAY TO HEALTH AND PRODUCTIVITY NBGH & TOWERS WATSON 2011/2012 STAYING@WORK ™SURVEY REPORT

Sources of Stress 2009 2011 % Change

Excessive workload / long hours 78% 87% 9% Lack of work life effectiveness 68% 79% 11% Inadequate staffing 51% 68% 17% Technologies that expand availability past work day 59% 63% 4% Unclear conflicting job expectations 46% 60% 14% Fears of job loss 67% 56% -11% Fears about benefit reductions 48% 47% -1% Low pay 44% Lack of supervisory support 34% 43% 9% Lack of technology, equipment, etc. to get job done 25% 34% 9%

Stress Recognized as a Major Problem

High Cost of Chronic Disease • 7 in 10 deaths

• ¼ with chronic disease

significant limitations

• 1960s 1.8% kids, 2011 43% kids

• Kids with chronic disease change families

America’s Fat Forecast

• Estimated by 2030, 32

million Americans will be obese or 42%

• Rate of severely obese will about double and reach 11%

• 50% of severely obese is a

result of childhood obesity

• 9 million or 27% of all 17-24 year olds are too fat to serve in the military

• Potential recruits failing physicals due to overweight or obesity is up 70%

• From 93’ to 08’ proportion of smokers declined by 18.5% , while proportion of obese increased by 85%

• Obese per person costs 56% higher than non-obese

Health and Human Services / Center for Disease Control (2012) QALY Lost Contributed in Smoking & Obesity (Jia 2010)

Healthcare Spending is Unsustainable

To

Businesses and

Individuals

Non-Visible Costs

Visible Costs

Indirect Costs represents 2-3 times Direct Medical Costs

Direct Medical Costs • Medical • Pharmaceutical

Indirect Costs • Presenteeism • STD / LTD • Absenteeism • Workers’ compensation

Iceberg Phenomenon and the Hidden Cost

The Question is No Longer Why Wellness But How?

Who, what, when, where, how often? What results can I expect and when can I expect them?

Young Adult Adult Pre-Retirement Family

Healthy

At Risk

High Risk No Chronic

disease

Disease MGT Eligible

Chronic Disease

Culture of safety is one in which employee behavior is guided by safety procedures, norms, and supports that encourage a safe working environment.

Safety behaviors are incorporated into the vision and goals of leadership.

Organizational factors that promote healthy lifestyle choices and inextricably linked aligning: • Leadership • Benefits • Policies • Incentives • Programming • Environmental supports

Baun, Workset (2009) & Aldana (2012)

-Perceived as a business asset -Recognized as having a big & important impact to the success of the organization -Leadership participation & encouragement

-Build a business case for senior management -Illustrate the value proposition to the organization -Pitch a comprehensive program -Build unit level management champions

Culture of Health

“Ultimately, a company needs to engage people at all levels of the organization to drive a culture of health forward.” Catherine Baase, MD Dow Chemical Health Director Employee Benefit News (2012)

Top Down ↓

Bottom Up↑

Six Essential Hard Return Pillars Regardless of Organizations Size

• Multilevel Leadership • Alignment • Scope, Relevance, and Quality • Accessibility • Partnerships • Communications

“We manage what we

measure.” Are you measuring

things that have high value in your

wellness programs?

Harvard Business Review Berry, Mirabito, Baun

Multilevel Leadership Capacity building – increasing the core wellness knowledge, skills and commitments through training, technology, and recognition. • Champ network • Neighborhood councils • Wellness Committee • Middle manager /

supervisors • C-Suite

• Planning and Patience – permeate the culture with wellness developing a long-term comprehensive strategy • Positive Incentives - promote trust & provide employees choices • Complement to Business Practices – must make business sense

Natural extension of a firm’s identify and aspirations…

Appropriate use of incentives

Recruitment rates improve and examples of short-term impact, but less evidence of long-term impact of behavior change. Madison, Volpp, Halpern (2011)

The effectiveness of outcome-based wellness incentives is uncertain and evidence is scant. Volpp, et. al. (2011)

Center for Health Incentives and Behavioral Economics

• More than Cholesterol – stress & depression major costs • Individualization – online health risk assessment combined with biometric data • Signature Program – high profile initiatives foster employee pride & involvement • Fun •High Standards – “no one will come for free and lousy” Needs vary

tremendously…

We Don’t do Wellness Alone

Many successful wellness steps and accomplishments are nudged through relationships..... Nudges are gradual, intentional positive interactions of encouragement to BE WELL

• Create grass root peer-to-peer efforts generating high interest and participation • Leader / champion maintains the group • Small group of under 10, self selected • Group decides goal, time commitment • Practice a behavior together: walking, eating, yoga, Tai Chi, stretching, meditation • Group agrees on metrics and measuring tools

Harness behavior change through small

change groups…

Accessibility

• Healthy cafeterias and vending • Walking trails and stairwells • Blood pressure machines • Bike racks and indoor bike barns • Lactation rooms • Stress buster stations • Be fit rooms / equipment • Quiet rooms • WOW (Wellness on Wheels) cart

Make the healthy choice the

easy choice…

Partnerships

• Partnerships are all about leveraging resources and building / maintaining a comprehensive program

• Internal partners align resources and help wellness gain credibility

• External partnerships enable the program to benefit from community resources and infrastructure without extra investment

• Tailor Messages - to fit the intended audience • Media Diversity – a variety of different communication tools to reach a audience • Embedded Wellness Clues –become a “viral thing” spreading throughout the workplace

Overcome individual apathy and personal

health sensitivity factors…

Six Essential Hard Return Pillars + Engagement • Multilevel Leadership • Alignment • Scope, Relevance, and

Quality • Accessibility • Partnerships

• Communications

Henry Albrecht Employee engagement is the holy grail of wellness and health and productivity programs. Employers that have achieved real returns from wellness programs recognize the role of engagement, but in the interconnected health, work, and personal factors we call life.

Rand Report Summary A Review of the U.S. Workplace Wellness Market

http://www.rand.org/content/dam/rand/pubs/research_reports /RR200/RR254/RAND_RR254.sum.pdf

• Workplace wellness programs a common employer-sponsored benefit / 50+ employers ½ have programs, but impact rarely formally evaluated

• Lifestyle management interventions can reduce risk factors, are sustainable over time and clinical meaningful

• Reason to believe reduction in medical costs would materialize, judging by program cost data after 5-program years, programs cost-neutral

• Engagement important obstacle to program success and use of incentives tied to health standards uncommon, but tobacco incentives growing

Worksite Wellness Hard Return Literature

Meta-Evaluation of Worksite Health Promotion Economic Return Studies: Update , Chapman

• Application of a systematic review process to evaluate studies and determine

respective quality and summarize findings, 650 formal worksite program evaluations – Medline 1966 to present

• Conclusion: summary evidence continues to be strong with average reduction in sick leave, health plan costs, and workers’ compensation and disability insurance cost of around 25%

Recent Experience in Health Promotion at Johnson & Johnson: Lower Health Spending, Strong Return on Investment • Program continues to evolve over the past 30 years • J&J experienced a 3.7 percentage points lower growth in annual total medical

spending • Average saving per employee $565, ROI $1.88-$3.92

Metric Aligned with Business Goals Leadership support

Champ network Environmental / policy supports Social and partnership supports Health benefit design Appropriate financial metrics Participation and satisfaction Engagement and improvement Wellness culture sustainability

“Engaged participants attend programs because they are intent on improving their health and are excited about contributing positive energy and productivity to their companies, families, and communities.” Terry & Anderson (StayWell)

You Can Make Wellness Happen!

Healthy Health Systems

Of 306 U.S. Hospital referral regions analyzed in the 2012 Commonwealth Fund study on access,

quality, costs and health outcomes, the Wisconsin regions of Appleton, La Crosse,

Green Bay and Neenah rank overall 5,7,12 and 14, respectively.

What is going on in Wisconsin?

Goals and Methods Of Research

Stable, Values-Driven Leadership: Management and Board of Directors

Common Success Drivers of Three High Performance Health Systems in Wisconsin

Jeff Thompson, at Gundersen Health since 1984, CEO since 2001

Dean Gruner, at ThedaCare since 1983, CEO since 2008

George Kerwin, at Bellin Health since 1971, CEO since 1992

• Stability at the top gives leaders the time to build trust in the organization and to strengthen its value system.

• Stability also gives leaders the confidence to be bold. • Stability enables leaders to lead, rather than follow.

Common Cultural Attributes of Gundersen Health, ThedaCare, and Bellin Health • Accountable • Ambitious • Bold • Collaborative • Confident • Data-driven • Empowered • Engaged

• Generous • Knowledge-seeking • Knowledge-sharing • Pride • Reflective • Unconventional • Unrelenting

“Improvement isn’t an interruption to the work,

improvement is the work.”

ThedaCare RN

Values-Driven Board Leadership Leveraging a Resource

Often Untapped in Healthcare

“Our board members are all personally successful people and they are not afraid to express their opinion. Many suggestions we make come back in terms of a revised proposal.”

Skip Lee, Finance Committee Chair

Bellin Health Board of Directors

“The management team looks at the board as a resource, not as the enemy. We deal with things openly and honestly. Management is willing to ask for our advice.”

Terry Fulwiler, Board Chair

Bellin Health

“The relationship between leadership and the Finance Committee of the board is one of respect and challenge. We know that we need to be prepared and accountable…There is no rubber stamping.”

Jim Dietsche, CFO, Bellin Health

Institutional Self -Confidence

Stable, Values-Driven Leadership: Management and Board of Directors

Common Success Drivers of Three High Performance Health Systems in Wisconsin

Institutional self-confidence paves the way to unconventional thinking,

to innovation, to high aspirations, to doing what is right and what is needed.

Institutional self-confident organizations are better at controlling their destiny.

Institutional self-confidence encourages competing for talent.

“We have a lot of talented physicians that have made their way to Appleton, Wisconsin. That is probably a little unusual.”

ThedaCare Executive

“People don’t come here for the weather.”

Gundersen Health Executive

Institutional self-confidence encourages active learning by

removing fear and fueling ambition

Learning from:

research and researchers

Institutional self-confidence encourages performance measurement and

internal and external transparency

(e.g. The Wisconsin Collaborative for Health Care Quality)

Institutional Self -Confidence

Broadened View of Value Creation

Stable, Values-Driven Leadership: Management and Board of Directors

Common Success Drivers of Three High Performance Health Systems in Wisconsin

Two Views of Value

QUALITY COST

BENEFITS BURDENS VS.

Collaborative Care at ThedaCare An Interdisciplinary Model of Inpatient Care

• Poorly coordinated care in hospitals is wasteful and potentially harmful; it creates needless burdens for patients.

• Collaborative Care integrates disciplines into a team that includes physician, nurse, pharmacist (at the bedside), and care manager to work with family and patient.

• Bedside care conferences (daily or more often): pre-huddle, in-room assessment, post huddle to evaluate and update the plan of work.

Institutional Self -Confidence

Broadened View of Value Creation

Focused Strategy

Stable, Values-Driven Leadership: Management and Board of Directors

Common Success Drivers of Three High Performance Health Systems in Wisconsin

Focused strategy guides resource allocation, balances priorities,

stimulates creativity, and facilitates excellence.

Strategic focus is not the enemy

of innovation, it is its ally.

ThedaCare’s True North Framework

Safety • System Patient Safety Bundle

• D.A.R.T.

Financial Stewardship • Operating Margin

• Productivity

People • Engagement Index

• HAT (Health Assessment Tool)

Customer (Lori) Customer Loyalty Score

Quality Preventable Mortality 30-Day Readmission

&

Institutional Self -Confidence

Broadened View of Value Creation

Focused Strategy

Embedded Improvement Mechanisms

Stable, Values-Driven Leadership: Management and Board of Directors

Common Success Drivers of Three High Performance Health Systems in Wisconsin

Business Process Reviews at Gundersen Health

• Twice a year, each service line presents to senior management a review of performance and plans for improvement.

• Presentations, made by the medical and administrative leaders of each unit, are organized along the five key strategies of Gundersen.

• All senior managers attend the sessions, which are interactive.

• At the end of the report, the CEO summarizes his impressions and follows up in writing. The BPRs embed accountability into the culture and better

equip physicians to be practice leaders.

Pioneering “Lean” at ThedaCare • A cultural commitment to applying the scientific method to

improve the work and value it creates. • Value-stream mapping of processes to distinguish between

discrete steps in the process that do or do not add value. • Team-based rapid improvement events every week to improve

processes. • Friday “Report Out” sessions in which RIE teams present the

results of their work using the True North framework. • Daily huddles throughout ThedaCare for staff to monitor

performance and suggest and implement improvements using the True North framework.

• A staff of Lean Facilitators who eventually move into management positions.

Institutional Self -Confidence

Broadened View of Value Creation

Focused Strategy

Embedded Improvement Mechanisms

Pooling of Talent

Stable, Values-Driven Leadership: Management and Board of Directors

Common Success Drivers of Three High Performance Health Systems in Wisconsin

Gundersen Health, ThedaCare, and Bellin Health leverage the power of

teamwork—individuals working collaboratively towards a common

purpose of high meaning.

Teamwork: NURTURES learning as teammates teach each other.

INSPIRES confidence as individuals stand with others, rather than alone.

ENCOURAGES extra effort because service providers know teammates are depending on them.

Different Models of Teamwork

• Intra-Unit teamwork (Breast Center at Gundersen) • Inter-Unit teamwork (Care Coordination at Gundersen) • Manager-Manager teamwork (physician leader-administrative leader structure at Gundersen) • Manager-Frontline teamwork (no-meeting zones at ThedaCare so managers can be on the floor)

Different Models of Teamwork • Manager-Board teamwork (Gundersen, ThedaCare and Bellin) • Clinician-Patient teamwork (Collaborative Care at ThedaCare) • Institution-Company teamwork (Employer onsite clinics run by Bellin) • Institution-Community agency teamwork (Stroke Team and EMS at Bellin)

Institutional Self -Confidence

Broadened View of Value Creation

Focused Strategy

Embedded Improvement Mechanisms

Pooling of Talent

Community Commitment

Stable, Values-Driven Leadership: Management and Board of Directors

Common Success Drivers of Three High Performance Health Systems in Wisconsin

Improving the quality of life in the broader community—

creating “social profit”—guides and motivates daily behavior at Gundersen Health, ThedaCare, and Bellin Health.

Creating social profit strengthens relationships, inspires employee

volunteerism, and differentiates the institution.

Social Profit is an input to success,

not just an outcome of success.

Bellin Vision

The people in our region will be the healthiest in the nation.

Bellin Run

Creating Social Profit

Bellin Health partnership with local schools (“Thrive”) to

encourage healthy living and exercise

among children, parents and staff.

ThedaCare’s convening and funding

community-wide projects (“Plunges”) to

address community problems, such as domestic violence.

Gundersen Health’s Environmental

Stewardship Program (“Envision”) that will meet 100% of energy needs for facilities by

2014.

Institutional Self -Confidence

Broadened View of Value Creation

Focused Strategy

Embedded Improvement Mechanisms

Pooling of Talent

Community Commitment

Stable, Values-Driven Leadership: Management and Board of Directors

Common Success Drivers of Three High Performance Health Systems in Wisconsin