Creating a Culture of Health A Call to Action: Creating a Culture of Health 2010 AHA Long Range Policy Committee Report January 2011

A Call to Action: Creating a Culture of Health A bold call to action for hospitals and their employees to be leaders in creating a culture of health Background on hospital health and wellness programs Findings from a groundbreaking AHA survey on hospital employee health and wellness activities Examples of hospital best practices “How-to" recommendations for the field Hospitals in Pursuit of Excellence (HPOE) is informed by and also informs the AHA’s advocacy work and our long-term system reform (Health for Life). HPOE is one of our 3 legs for AHA as it relates to our overall mission.

Why Health and Wellness? Hospital and health system employees play critical role in their communities to lead the way and serve as role models for healthy living and fitness Financial case for creating a culture of health through potential cost savings and improved employee recruitment and retention Hospitals and health systems contributing to achievement of national public health goals in Healthy People 2020 ACA incentives to promote employee health and wellness HPOE is the AHA strategy for accelerating performance improvement. HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow). In the last few months HPOE added 2 more topics: care coordination and implementing HIT. The next topic for HPOE is improving efficiency.

Survey on Hospital Employee Health and Wellness Activities National survey of hospital employee health and wellness activities conducted May-June 2010 876 responses nationally representative of all hospitals in terms of hospital size, teaching status, and census region urban hospitals and hospitals that were members of a health system slightly overrepresented HPOE is the AHA strategy for accelerating performance improvement. HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow). In the last few months HPOE added 2 more topics: care coordination and implementing HIT. The next topic for HPOE is improving efficiency.

Survey on Hospital Employee Health and Wellness Activities Most hospitals (86%) have an employee health and wellness program, the vast majority of which (80%) are directly administered by the hospital or health system. The top motivators for offering a program are to reduce healthcare costs, improve the health of employees and reduce absenteeism/presenteeism, improve employee morale and productivity, and provide an example to the community. The most common wellness programs offered include flu shots, EAP/mental health services, smoking cessation programs, and healthy food options. HPOE is the AHA strategy for accelerating performance improvement. HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow). In the last few months HPOE added 2 more topics: care coordination and implementing HIT. The next topic for HPOE is improving efficiency.

Survey on Hospital Employee Health and Wellness Activities There is a wide variation in the percentage of hospital employees participating in health and wellness programs, with 42% of hospitals reporting that at least half of their employees participate in one or more programs. Hospitals promote their wellness programs through health fairs (76%), health risk assessments (70%), and incentives (66%). The overwhelming majority of hospitals that offer incentives use positive incentives such as health insurance premium discounts or gift cards. HPOE is the AHA strategy for accelerating performance improvement. HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow). In the last few months HPOE added 2 more topics: care coordination and implementing HIT. The next topic for HPOE is improving efficiency.

Survey on Hospital Employee Health and Wellness Activities Most hospitals (76%) require that employees participate in at least one wellness program. Many hospitals also offer incentives for employees who complete a wellness program (50%) and achieve outcomes based on participation (39%). HRA completion, participation in weight management or smoking cessation program, and completion of a biometric screening are activities commonly linked to incentives. Hospitals with more than 200 beds are more likely to utilize incentives. HPOE is the AHA strategy for accelerating performance improvement. HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow). In the last few months HPOE added 2 more topics: care coordination and implementing HIT. The next topic for HPOE is improving efficiency.

Survey on Hospital Employee Health and Wellness Activities Slightly less than half (47%) of hospitals that use incentives discount between 5% and 20% of an employee’s monthly premium for participating in health and wellness programs. A third of hospitals that use incentives award employees who meet health and wellness incentives between $100 and $300 annually. An additional 41% of hospitals award $100 or less. HPOE is the AHA strategy for accelerating performance improvement. HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow). In the last few months HPOE added 2 more topics: care coordination and implementing HIT. The next topic for HPOE is improving efficiency.

Survey on Hospital Employee Health and Wellness Activities One-third of hospitals have made an attempt to measure the return on investment (ROI) of employee health and wellness programs, and only 7% have successfully measured ROI. Of those who have successfully measured ROI, the current median ROI of health and wellness initiatives is between 2:1 and 3:1. Eighty-two percent (82%) of respondents who measure ROI report that their ratio is equal to or exceeds expectations. The most common measures used in evaluating ROI are number of participants, number of completed HRAs, overall direct health care costs, number exercising regularly, and number achieving weight loss. HPOE is the AHA strategy for accelerating performance improvement. HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow). In the last few months HPOE added 2 more topics: care coordination and implementing HIT. The next topic for HPOE is improving efficiency.

Survey on Hospital Employee Health and Wellness Activities Motivating employees over extended time periods, financial restrictions or limitations, measuring program effectiveness, and creating a culture of health are noted as the most serious challenges to program effectiveness. Urban hospitals and hospitals with more than 200 beds find it more challenging to communicate to their employees about health and wellness activities. Getting better ROI data is the most important opportunity for improving health and wellness programs. Additional opportunities include providing more incentives to employees, providing new programs, and providing different types of incentives. HPOE is the AHA strategy for accelerating performance improvement. HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow). In the last few months HPOE added 2 more topics: care coordination and implementing HIT. The next topic for HPOE is improving efficiency.

Our Recommendations Serve as a role model of health for the community. Create a culture of healthy living. Provide a variety of program offerings. Provide positive and negative incentives. Track participation and outcomes. Measure for ROI. Focus on sustainability. HPOE is the AHA strategy for accelerating performance improvement. HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow). In the last few months HPOE added 2 more topics: care coordination and implementing HIT. The next topic for HPOE is improving efficiency.

Serve as a role model of health for the community. Recommendations Serve as a role model of health for the community. Use wellness programs as pilots to export to the whole community as part of a population-based approach to health care Offer health and wellness program benefits to all dependents of employees Work with local employers to build an integrated, regional approach to health and wellness Provide free wellness programs at local community centers. HPOE supports the field by 3 main ways: Education Products National Implementation Efforts We will discuss each of these in detail, but quickly: Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sources Products are our toolkits and guides, such as the readmissions action guide that we will discuss later. National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

2. Create a culture of healthy living. Recommendations 2. Create a culture of healthy living. Promote a holistic approach to wellness Start commitment to culture change at the top—with the CEO and the board of trustees Consider creating a wellness department led by a chief wellness officer who reports directly to the CEO Make changes to the work environment that promote healthy behavior HPOE supports the field by 3 main ways: Education Products National Implementation Efforts We will discuss each of these in detail, but quickly: Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sources Products are our toolkits and guides, such as the readmissions action guide that we will discuss later. National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

3. Provide a variety of program offerings. Recommendations 3. Provide a variety of program offerings. Include a health risk assessment (HRA) and biometric screening in all hospital wellness programs Implement at least one intensive coaching activity Make smoking cessation mandatory for all employees and subsidize and/or offer only healthy food options in all hospital cafeterias and vending machines Re-evaluate wellness programs annually and adjust as necessary HPOE supports the field by 3 main ways: Education Products National Implementation Efforts We will discuss each of these in detail, but quickly: Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sources Products are our toolkits and guides, such as the readmissions action guide that we will discuss later. National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

4. Provide positive and negative incentives. Recommendations 4. Provide positive and negative incentives. Expand use of incentives to improve participation levels Experiment with various types of incentives and measure effect on participation and outcomes Shift toward more outcomes-based incentives as participation increases HPOE supports the field by 3 main ways: Education Products National Implementation Efforts We will discuss each of these in detail, but quickly: Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sources Products are our toolkits and guides, such as the readmissions action guide that we will discuss later. National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

5. Track participation and outcomes. Recommendations 5. Track participation and outcomes. Initially focus on measuring and increasing participation levels, then move on to tracking outcomes Track participation levels in a number of ways, e.g., number of overall participants, number completing a HRA, number enrolled in smoking cessation programs Track outcomes in a number of ways, e.g., number who achieved weight loss, number who ceased smoking HPOE supports the field by 3 main ways: Education Products National Implementation Efforts We will discuss each of these in detail, but quickly: Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sources Products are our toolkits and guides, such as the readmissions action guide that we will discuss later. National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

Recommendations 6. Measure for ROI. Ensure multi-year commitment to measurement, evaluation and improvement Start small by measuring ROI on subset of wellness programs Focus attention on finding effective metrics—”hard” and “soft”—that work for your institution For validity, match employees who have undergone an intervention with employees with similar characteristics who did not participate HPOE supports the field by 3 main ways: Education Products National Implementation Efforts We will discuss each of these in detail, but quickly: Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sources Products are our toolkits and guides, such as the readmissions action guide that we will discuss later. National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

7. Focus on sustainability. Recommendations 7. Focus on sustainability. Approach wellness as a constant activity, not just an annual event Dedicate resources to constantly communicate—through multiple modes and media—with staff, educate and incentivize participation If necessary, start small, demonstrate success, and build up to full range of wellness activities Change programs and incentives as necessary to maintain high levels of participation HPOE supports the field by 3 main ways: Education Products National Implementation Efforts We will discuss each of these in detail, but quickly: Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sources Products are our toolkits and guides, such as the readmissions action guide that we will discuss later. National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

Health and Wellness Best Practices Hospital/Health System Best Practice Truman Medical Centers, Kansas City, MO “PTO for Wellness” program – allows employees to trade paid time off (PTO) hours for reimbursements for wellness-related expenses Ochsner Health System, Jefferson, LA Voluntary wellness program with significant insurance premium discount Sentara Healthcare, Norfolk, VA Mission: Health, an incentive-based wellness and disease management program St. Elizabeth Medical Center, Wabasha, MN Robust wellness program with numerous offerings that is managed by a wellness committee HCA, Inc., Nashville, TN Calculates ROI of a diabetes pilot program in multiple ways, with a focus on clinical outcomes and claims-reduction data Henry Ford Health System, Detroit, MI Developing data collection methodology at beginning of interventional, controlled trial for chronic back pain with major employer provided data to expand program to other employers and community organizations

A Call to Action: Creating a Culture of Health Hospitals in Pursuit of Excellence (HPOE) is informed by and also informs the AHA’s advocacy work and our long-term system reform (Health for Life). HPOE is one of our 3 legs for AHA as it relates to our overall mission. www.aha.org/wellness