Worksites are where most adults spend more than half of their waking hours . In light of this, they offer a unique opportunity to affect change in an individual’s health status. Billions of dollars are spent each year addressing health in the workforce only after illness and/or injury has already occurred (2). This translates to profit losses in the form of lost wages and compensation, productivity, and high employee turnover. Employees also pay a high physical and emotional price for poor health. Rising healthcare costs are also passed along to the consumers who share the burden of higher premiums, deductibles, and copayments (3). Prevention is the key in addressing issues in a proactive manner.
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For most organizations, this phenomenon is reflected in a high utilization of personal time off and requested sick leaves (2) (4) (5). A related issue is the abuse of the sick leave benefit where employees feel a stress-day off is a benefit and at their discretion. This is often related to stress in the work place or a work place environment that is uncomfortable for the employee (6). Past efforts to control this issue have included requiring physician certification of a valid health problem, implementing company policies that limit utilization of ad hoc time off, and encouraging managers to say no when asked for excessive days off. Some companies have even eliminated the concept of a sick day and increased the employee’s personal time off by a day or two to compensate (6). Regardless of the labeling for time off or of the managements’ effort to control increased health related issues, many organizations report that employees’ taking unplanned days off has increased (4). The recommendation is to move away from the confrontational approach of imposing corporate rules to limit the abuse and focus on the core of the problem, health problems and stress management in the workplace (2) (5).
A human resources (HR) industry survey found that reported personal illness accounts for 35 percent of all unscheduled absences in the workplace (4). Some HR experts estimate that absenteeism can cost a company around $600 per employee per year, and that’s just in use of benefits and healthcare costs. The estimates are higher if the calculation includes other related costs such as overtime pay, costs of temps, missed deadlines, and lower productivity (7). Some of these unaccounted for sick days can be avoided if the company’s management is proactive when making organizational changes and in providing means for helping employees deal with health issues (1-5).
This increased utilization is driving up the cost of coverage and company officials are considering some desperate options to save money such as a drastic reduction of coverage or the elimination of benefits altogether. Prior to the implementation of such measures, company executives need to consider a different approach upon which they feel may not only raise awareness of health and safety issues, but provide the tools necessary for employees to increase their quality of life. The Healthy People 2010 initiative is a government effort to promote employers to get involved in the health of their workers with the intended goal being to “Increase quality and years of healthy life” (3). One area recommended is to implement an employee wellness program that addresses staying healthy, increasing exercise opportunities, and reducing worksite injuries through increase safety practices (1) (2) (5).
Employee wellness programs are predicated on the basis that most illness is directly preventable and that the workplace has the ability to transform lives (1). Companies that implement programs will see a decrease in healthcare costs by lowering utilization rates of sick days and improving the workplace environment (2) (5). These programs are meant to improve the overall quality of life for each of their employees (3).
Statement of the Problem
The purpose of this study was to determine if an organization takes proactive efforts to implement healthy programs that can positively influence a reduction of sick days used by employees. Researchers have found significant cost savings for the organization by taking the action of becoming involved in the wellness of employees (2) (5). The use of sick days, whether due to illness or a need for a personal day away from stress, result in higher costs due to issues such as overtime pay, costs of temps, missed deadlines, and lower productivity (7). Healthy Workforce 2010 (3), a program within the Healthy People 2010 initiative, recommends employer groups take an active role in implementing programs, such as an employee wellness program, in order to improve the overall health of their employees and subsequently creating a healthier work environment.
Hypothesis 1. The introduction and management of a worksite wellness program at a manufacturing organization will improve the overall health and wellness of their employees.
Hypothesis 2. There will be a significant decrease in the number of personal days off and sick time, as reported to Human Resources, based on improved employee health and satisfaction at their workplace as a result of implementing a workforce wellness program.
Hypothesis 3. There will be an increase in employee knowledge and skills for healthier living as measured by a pre and post-test measuring the amount of information gained from interventions such as onsite workplace classes.
If these of hypothesis do not prove true, the researcher expects that the organization will still experience costs equal to or exceeding that of previous years in health related time off, which will be reflected in personal time off (PTO) or sick days (STO) utilization rates. Employees may show an increase in knowledge of healthier lifestyle changes but this may not change their behaviors surrounding time off and implied expectations of utilizing a company benefit.
This study’s focus is on reducing the overall costs to an organization as impacted by the over-use of PTO and STO by employees. The actual cost savings are estimated to include reduction in other areas such as overtime, hiring of temps, and production losses. But to keep this study’s outcomes in a reasonable space, the only measurements for success will be the reduction of overall usage of time off or PTO and STO per 100 employees. The base measurement for this analysis will be statistics from previous years.
In order to keep the number of employees and impact at a manageable level, the study will only review the effects of a wellness program on one organization, a large manufacturing organization in a suburb outside of Los Angeles, California. The organization has over 600 employees at the target location, consisting administrators, engineers, line supervisors, and skilled factory workers. Managers have reported an average expected utilization of time off related to health and stress issues.
Since the study will focus on a specific population in a specific industry, the results may reflect the impact of a program that is only successful under certain environmental influences. Also, a CCH survey (6) discusses the abuse of PTO or STO days, highlighting that use of these days are influenced by various reasons in addition to sickness or stress. Some areas indicated in surveys (4) include family illnesses or problems, which may not be impacted by a wellness program, and seasonal influences such as summer or holidays, which often results in 4 day weekends.
The study is relying upon the information collected by the HR representatives of the organization, which limits the analysis to days reported to HR and avoiding comp time or personal days which are taken as agreements between supervisors and employees. Since the baseline will be the reported days from previous years, this limitation should have little impact on the outcome of the study.
In defining this study, the following assumptions were made:
All time off is reported and tracked by the HR department.
Since illnesses and stress leave are human-based factors and not necessarily bound to a specific industry, the results of this study will be applicable to other industries and workers.
Implementing a program that focuses on reported time off will not unduly influence an increase or decrease in reported days due to the study itself.
Since the study is qualitative, the results will be only be the starting point for other studies that should include other factors that may influence increased use of personal days off.
PTO – Personal Time Off, a company benefit for employees of most organizations.
STO – Sick Time Off, a company benefits only offered at some organizations; some companies have rolled sick time into the personal time benefit.
MATCH – Multilevel Approach to Community Health. A five-phase program planning model developed in the late 1980s.
Normative Need – The needs of a population based on expert opinion.
Expressed Need – The needs of a population based on factual data.
Healthy People 2010 – U.S government publication that brought together much of what was known about the relationship of personal health behavior and health status.
Primary Data – Original data collected by the planners.
Lifestyle Disease – A disease that is associated with how a person lives. Such as their smoking habits, alcohol, drug abuse, physical activity and eating habits. Lifestyle diseases include, heart disease, stroke, obesity, and type 2 diabetes.
Risk Factors – is a variable that is associated with increased risk of disease or infection. Risk factors can include, lack of physical activity, diet, etc.
Wellness – Wellness is an active process through which people become aware of, and make choices towards, a more successful existence (8).
Absenteeism – is defined as a chronic absence and in this context it is in relation to work.
Non-communicative diseases – diseases that are not infectious. These disease include those that are from genetic or lifestyle factors.
Segmentation – process of identifying groups of consumers that share similar characteristics and will respond in a like way to a marketing strategy.
Over 100 years ago, the biggest health care threat we faced had to do with the spread of communicable diseases. Today, communicable diseases take a back seat to a much bigger problem that plagues American citizens which is that of lifestyle origin. A lifestyle disease is defined as one that is affected by factors such as poor dietary habits, alcohol and/or drug usage including tobacco smoking, and lack of physical activity (9). These factors individually as well as in combination make a person much more susceptible to cardiovascular diseases, hypertension, obesity, and certain types of cancers. In order to reduce the risk of these diseases, individuals must address changes to their lifestyles that include participating in workplace healthy wellness programs. This chapter will review the influencing factors in the effort, the scope of the problem of lifestyle diseases, and discuss some of the benefits of targeting specific areas in a wellness program.
Addressing Lifestyle Changes
Researchers have shown found a direct relationship between providing intervention to improve a person’s health and the cost saving realized by that person’s employer (1) (2) (5).Taking proactive measure to improve the person’s health and to implement preventative measures keeping the person out of a high-risk category for lifestyle diseases extends the person’s life and benefits everyone they are involved with, from their employer to their families (1). Some researchers found the reverse to be true also. Ignoring the factors identifying people by their risk for lifestyle diseases will result in an increase of health problems and in costs to the employer through use of sick time and increased workplace injuries (2) (5).
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Modifying an individual’s risk factors for lifestyle diseases can be difficult. People usually express a lack of time outside of the workplace for healthy behaviors such as meal planning and exercise; since, half of our waking hours are spent at work (9). In addition to time constraints, beginning any new healthy lifestyle behavior is no easy task, but it can make a profound effect on both physical as well as mental health. These benefits hold true regardless of the worker’s age. One large cohort study of 15,708 examined the impact of adoption of new lifestyle behaviors (9). All individuals were of typical working age 45-64. It was found that people who newly adopt a healthy lifestyle in middle-age experience a prompt benefit of lower rates of cardiovascular disease and mortality. Further conclusions recommend that we begin to adopt strategies to encourage healthy lifestyles. This is especially true among those with pre-existing medical conditions such as hypertension, diabetes, or obesity (9).
Lifestyle changes not only take commitment on the part of the participant but a great deal of support from others as well. Support from co-workers can be a strong motivator but in order for healthy changes to be fully adopted by the workforce, it must be a priority among the decision makers within the company (2) (5). The cost impact of a disease such as obesity is well documented. Obesity contributes to monetary losses for the employee as well as employer. In response, employers continue to look for ways to offset those costs through the offering of company-sponsored wellness and weight management programs. Health care organizations in particular hospitals, as well as public employers can be important role models in this process. A change in policy could make a dramatic difference for smaller employers which represent the majority of U.S. employers as they are far less likely to offer health promotion programs unless a government incentive was offered (10).
Worksites are where most adults spend more than half of their waking hours. In light of this, they offer a unique opportunity to affect change in an individual’s health status. Health in the workplace should focus on one main role central to prevention. Prevention tactics can be geared towards prevention of illness and spread of disease as well as prevention of accidents, injury, and disability. Billions of dollars are spent each year addressing health in the workplace only after illness and/or injury has already occurred (11). This translates to profit losses in the form of lost wages and compensation, productivity, and high employee turnover. Prevention is the key in addressing issues in a proactive manner.
Wellness programs are an important component of employer benefits packages because they offer workers and their families’ choices for pursuing healthier lifestyles with less illness, ultimately leading to less costly benefits packages (9). Wellness programs and employee assistance programs are important benefits for workers and their employers; data from the National Compensation Survey (NCS) show that workers in the public and private sectors had greater access to these kinds of benefits in 2008 than they did a decade earlier. In an age of ever-increasing health care costs, services that promote health and wellness have become an important element of U.S. society. Wellness programs often include health education and an awareness component. According to some analysts, these programs address issues that increase worker satisfaction and productivity.
Implementing a Wellness Program Using MATCH
Researchers have found the employers who implement proactive, work-based wellness programs can realize significant savings in utilization of STO, decreased productivity and costs for production lags (2) (5). In one study, researchers implemented a worksite health promotion program to reduce the utilization of short-term disability days at a large company. The researchers estimated the potential cost savings over a 2-year period would be in excess of $1,300,000 (2). A similar study that implemented a health-promotion program over five years found estimated cost savings from reduced sick days at over $600,000 a year (5). The target populations in both of these studies focused on employees who were high users of sick days. Expanding that approach to the entire population should contribute even more to the cost savings.
Affecting change in a population with varying influential levels is strength in the program design called the Match Model. Match is an acronym for Multilevel Approach to Community Health (12). The concept behind the Match Model is based on attempts to reach various levels within a target population through working with individuals of influence at various levels. Once appropriate goals are selected in the Match Model, intervention planning begins with the selection of objectives and approaches. The program development then commences with the creation of the actual delivery pieces such as information materials and class curricula.
The preparation for implementation is the next step whereby key individuals who will deliver the intervention are trained, roll out dates established, and the program actually begins. The final step in the Match Model involves the program evaluation process. This critical step provides the program development team with outcomes measures to evaluate the program effectiveness and provide necessary feedback that will drive future programs.
Worker Health in the United States
Worker health in the United States is a broad issue. Multiple political initiatives have been recently developed in an effort to address the problems that have arisen as a result of national attention to multiple health concerns that currently plague the country which includes rising obesity rates, type II diabetes, tobacco usage, as well as a host of other issues. An example of a set of national health initiatives is the Healthy People 2010 (3) objectives, aimed at making a difference in 10 years. Many of the initiatives contained within are aimed at increasing quality of life through the prevention of disease. The program has “a total of 467 objectives organized into 28 focus areas. There are special provisions for physical activity, tobacco usage, and obesity” (3). The program also addresses issues for employers such as high utilization of benefits, increased absenteeism, and productivity issues, all resulting in high-cost employees especially those who experience multiple risk factors for diseases including high blood pressure, smoking, and sedentary lifestyles (3).
Top reasons for taking what might be called non-sick days are family issues (21 percent), personal needs (18 percent), entitlement mentality (14 percent), and stress (12 percent). Lisa Franke, a workplace analyst at CCH, says that absences for stress and entitlement – taking days employees believe they have “earned” – are up slightly from last year because “leaner staffing levels have intensified workloads” (13).
Based on these findings, recommendations to employers in the United States are focused around two main factors. The first recommendation from the Healthy People 2010 program is that employers, at least 75% of those in the United States regardless of size, should offer a comprehensive employee health promotion program. The second recommendation is that employer groups should strive for a 75% participation rate among all employees. The objectives of Healthy People 2010 sparked a subsidiary report known as Healthy Workforce 2010 (3). The report outlines eight primary objectives that promote health and quality of life among workers in the United States.
Among the objectives presented in the report, the researchers highlighted the impact of unhealthy habits of the U.S. population on the economy and future of the country. In 1998, the report estimates that a quarter of the adult population smoked; this statistic is even higher at 35% for American teenagers. Other vices such as alcohol and drug abuse have cost the U.S. economy over $276 billion dollars as a result of “healthcare, auto accidents, lost productivity, and other issues” (3).
In addition to problems created by substance abuse, the Healthy Workforce 2010 report estimates that over half of the U.S. population is overweight or classified as obese. This problem can be addressed by encouraging employees to participate in regular daily exercise. Similar to substance abuse among workers, this growing problem results in related diseases such as cardiovascular disease, type II diabetes, and osteoarthritis which costs both employers and the U.S. economy in healthcare costs (3).
Other areas resulting in higher healthcare costs and impacting the work area include addressing work-related injuries and providing a safe working environment for employees. Even beyond the deaths caused by work accidents, the U.S. Bureau of Labor estimates that employees experience approximately 5.7 million non-fatal accidents annually, resulting in over 2.7 million lost work days. The Healthy Workforce 2010 recommends employers not only focus on preventing accidents but also increase healthcare coverage, since the U.S. Census Bureau reports that over 42 million American workers are not covered by health insurance, a trend predominant in smaller companies (3).
Worker Health in California
Studies from the State of California Department of Health (14) reported similar findings at the national level. The larger issues that appear to be problematic in the State of California involve lost wages and productivity caused by diseases that are aggravated by unhealthy lifestyles. These include obesity, hypertension, and cardiovascular complications among others. The literature revealed that worksite wellness programs help to reduce overall operating costs from increased healthcare utilization, accidents and poor productivity. Employers also benefit from these programs through enhanced recruitment, retention of healthy employees, and reduced absenteeism (15).
The easiest way to address health related issues is to take actions that prevent the problems in the first place. Primary healthcare measures are the key to ensuring a healthy population.
Worker Health in Los Angeles County
Similar reports in Los Angeles County provided population-wide data on health related quality of life in Los Angeles County and used measures developed by the Centers for Disease Control and Prevention to track health trends at the national and state levels. The average numbers of unhealthy days and activity limitation days were higher in Los Angeles County (6.4 and 2.4, respectively) than in California (5.9 and 2.1) and the United States (5.5 and 1.9, respectively) in 1999. These differences may reflect disparities in health status across the three populations but as well as demographic differences (e.g., socioeconomic or racial/ ethnic differences) between the populations. In addition the number of unhealthy days and activity limitation days were significantly higher in persons previously diagnosed with depression, arthritis, diabetes, heart disease, or asthma than in persons not diagnosed with these conditions (16).
Health Consequences for Workers
Employees also pay a high physical and emotional price for poor health. Rising healthcare costs are passed along to the consumers who share the burden of higher premiums, deductibles, and copayments. Financial responsibilities can lead to increased stress levels among workers. Employee wellness programs are predicated on the basis that most illness is directly preventable and that the workplace has the ability to transform lives. These programs also decrease healthcare costs through lowering utilization rates. These programs are meant to improve the overall quality of life for each of the participants (3).
The Importance of Physical Activity
Regular physical activity provides a multitude of benefits to an employee. According to the American Council on Exercise (11) “low-back pain is a leading cause of job-related disability and missed work in the United States.” This problem results in over $50 billion every year in healthcare costs. Work-related back pain experienced by most people can be prevented with just a little forethought. In high-risk back pain jobs requiring frequent bending, lifting, and twisting, employees and employers can be taught a variety of methods in order to reduce stress on the back and help prevent injuries. This risk of injury increases in those who are overweight, smoke or are inactive (11).
Benefits of Smoking Cessation
According a report conducted by the Center for Disease Control and Prevention (17) over 8.6 million people in the U.S. experience a health-related problem due to smoking. In the subsequent CDC report the next year (17), the agency reported that smoking was responsible for over 90% of lung cancer mortalities and over 80% of the COPD (emphysema and chronic bronchitis) deaths. This is largely because cigarettes and other tobacco products contain over 4,800 chemical, 69 of those which have been identified as carcinogenic. Smoking has also been linked to other serious illnesses and medical problems such as slow wound healing, peptic ulcers, and other diseases contributing to loss of employee productivity (18). Employers have responded by creating smoke-free workplaces nationwide, where employees can be protected from the life-threatening effects of secondhand smoke. In 1999, a study found that approximately 70% of the U.S. workforce was impacted by a smoke-free employer policy (19). But laws and employer responsibility varies by state, so this statistic can vary above 80% in states like Utah and Maryland or drop below 50% in states like Nevada (19).
Healthy Diet Advantages
According to the American Diabetes Association (ADA) (20), diabetes is one of the fastest growing and one of the most costly health issues facing the U.S. worker. The disease has reached epidemic proportions in the United States, affecting a growing number and percentage of people every year. The cost of diabetes to the American healthcare system is staggering, resulting in missed work days and higher benefit requirements for employers. In the ADA report, one-fifth of the healthcare dollars spent is used to provide care for someone with diabetes, while one-tenth of the healthcare dollars spent is associated with diabetes. For employers, the costs of diabetes increased 32% from 2002 to 2007, with the increase in medical expenditures and lost productivity estimated at $174 billion. Per capita, the annual cost of diabetes is approximately $11,744 a year. Many people do not recognize that they are at risk for diabetes (or diabetes-related complications if they already have diabetes). However, type II diabetes can be prevented or delayed for many of those at high risk for diabetes and diabetes-related complications can be also be prevented or delayed with lifestyle practices including maintaining a healthy weight, regular exercise, and a balanced diet (20).
The prevalence of lifestyle diseases among Californians and within the U.S. is growing. Everything from fast foods to sedentary activities plays a role in contributing to this national problem. Addressing the issues requires more than just adding a few cardio sessions every week or walking a little more, the effort requires attacking the problem at the root, changing how people define and move through their lives. Lifestyles changes are exactly that, changes that affects across a person’s life and hopefully for the rest of their lives. Many factors contribute to lifestyle diseases include home culture, resting activities, and work environments. Implementing a wellness program at a worksite will provide the support and information needed to make effective changes to the employee’s health while benefiting both the employee and employer (2).
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