Worksite Wellness

This headline caught my eye in the NBC Health News “Smoking employees cost $6,000 a year more, study finds.” Is it no wonder why there are more and more employersCost of smoking seeking to put smoking policies into the workplace?

The study by Micah Berman of Ohio State University, was a culmination of reviewing studies on health care costs, presenteeism – “when people are at work but not putting in full effort” states Berman. In addition, Berman and his colleagues, reviewed studies that calculated the cost of more sick days by smokers and the cost of employee smoke breaks. Smoke breaks were included in lost productivity of smokers taking longer breaks due to the smoking ban within the workplace.

In the booklet Save Lives, Save Money, Make your Business Smoke-Free by the Center for Disease Control and Prevention (CDC),  have a few unexpected reasons why a smoke-free work place is good for the bottom line.

  • Going smoke-free reduces the risk of fires and accidental injuries
  • Going smoke-free reduces cleaning and maintenance costs
  • Going smoke-free reduces potential legal liability for legal suits from non-smokers

Here are a few tips from the CDC if you want to implement a workplace smoking policy:

  • Give yourself six months to a year to plan the new policy
  • Set up a task force to oversee the process, include top management, smokers, non-smokers
  • Gather information to educate the task force. Survey your employees to understand their needs and concerns.
  • Write the policy. Keep it clear, simple and straightforward. Address how the policy will work and how it will enforced.
  • Announce the policy. Several months before the start date send out a letter from top management to introduce policy.
  • Offer support to all employees who want to quit smoking, such as free or reimbursed cessation programs on-site or through local providers, and nicotine replacement therapy.
  • Start policy
  • Monitor the policy and continue to get feedback from both employees and other stakeholder groups.

Implementing a smoke-free workplace policy will create both healthier employees as well as a healthier business bottom line.

Perhaps you’ve had an experience similar to one I had, one of those life lessons that you never forget. I was working in a rather intense client situation with a large New York City financial services company. The company I was working foImager at the time was delivering a highly customized service, something we had never done before. And at that particular moment, we weren’t doing a great job for the client. I remember the client saying to me ‘If you can’t measure it, you can’t manage it.” Seems pretty basic, right? But it served as that slap upside the head that told me I needed to focus on ways to measure what we were doing so we could tell the story of the services we were providing and how the client was benefiting.

Many years later, I think of this often in the work we do with worksite health promotion programs. Measuring and evaluating wellness programs is a critical success factor and a best practice.

Why measure and evaluate?

Measuring and evaluating your wellness program serves to:

  • Assist in improving the present program.  Getting regular and consistent feedback from participants allows you to make immediate adjustments to improve on meeting the needs of participants.
  • Demonstrate program value and magnitude of impact to senior management. With this information, the program coordinator is in an excellent position to use the results to educate senior management on the benefits of the workplace wellness program, and to secure their support for future program growth.
  • Justifying proposed budgets at budget planning sessions in the organization.  Without the data provided by evaluation efforts, securing future budget increases may be more difficult.
  • Planning future programming changes, it may be necessary to compare the efficacy of different interventions – the success of one intervention vs. another.  New approaches are always being developed and having comparative data will help in making decisions about which intervention is best for your population.

How to measure and evaluate?

When developing your plan for evaluation, think about measuring in three different areas: process, impact, and outcomes.

Process Evaluation

This type of evaluation is best used to assess the intervention content by looking at methods, program materials, instructors and participation rates. Evaluate how the process worked in developing the program

  • How the program is structured
  • How it is promoted
  • How it is funded
  • How decisions are made.

This is useful identifying a need to modify the marketing strategy, identifying how participants are targeted and how program facilitators are utilized and the effectiveness of materials used.

Impact Evaluation

This type of evaluation assesses the impact of the interventions on the population targeted.  It measures:

  • Have participants demonstrated any behavioral or biometric changes using objective measures such as blood pressure readings, HRAs and changes in the numbers of smokers.
  • Are there changes in knowledge, attitudes and behavior can also be measured using pre and post participation questionnaires.
  • Combine with biometric data for complete picture.
  • The results from impact evaluation may be used to guide program planning moving forward

Outcomes Evaluation

Every once in a while, we have to step back and look at the big picture. Outcomes evaluation helps us do this. The outcomes results we hope to measure are:

  • Have there been any changes in the organization such as cost-effectiveness, cost benefit and return on investment.
  • The variables to examine are productivity, absenteeism, employee moral and utilization of health care.
  • If it’s not feasible to do, existing literature may be used as support for the organizational benefits from program outcomes.
  • Typically outcome evaluation takes place yearly with a snapshot of the organization taken in the beginning compared to the snapshot a year later.

Where to start?

Start by taking the time to develop an evaluation strategy and plan. Use the same business planning processes you use for other aspects of your business to:

  • Determine evaluation objectives.
  • Identify the programmatic components to be evaluated.
  • Identify proposed evaluation methods for each program objective.
  • Identify evaluation tools.
  • Identify how the evaluation results will be used.

In the long run, when you are asked ‘is your program working and providing results’, your evaluation efforts will help you answer the question.



To create a meaningful wellness program that will align with the specific health needs of your company and engage employees in a culture of wellness, it is important to create a Wellness Committee made up of volunteers from all areas of your workforce.

A Wellness Committee represents all stakeholder groups who will ultimately participate in your wellness program, from management to shift workers and is led by an appointed “Wellness Champion,” who should be someone who has the ability to develop agendas, keep the team on task , define priorities, and effectively communicate with, and motivate others. The Wellness Committee members are the advocates for workplace policies and environment changes that support the wellness program. Most importantly, they serve as champions and role models for the program by actively participating in the Wellness Program and encouraging fellow employees to do the same.

Managerial support of the Wellness Committee and its recommendations is paramount to the success of any wellness program. The responsibilities of the Wellness Committee must be considered by management to be a part of their job descriptions and, thus, should be fully supported and subject to performance review.

The reason a Wellness Committee is so important to the sustainability of a worksite wellness program is that it makes it personal. Rather than presenting a pre-packaged set of activities that any company could do, it creates a sense of ownership for the wellness program and allows it to form into something unique to your company and your employees.

When it comes to tobacco use, our nation has come a long way. Between 1965 (when the first US general’s report came out) and 2000, rates dropped rapidly from almost 45% of American adults who smoked to approximately 25% in 2000 (Centers for Disease Control and Prevention).  However, since 2000 rates have steadied out – at about 19.3% as of 2010. Smoking is still costing the US more than it can afford. Smoking costs US businesses $97 billion dollars each year in productivity losses alone (Centers for Disease Control and Prevention, 2008).

People smoke for a number of reasons, including relief from stress or other discomforts, distraction, enjoyment, a concentration aid, social reasons, or for added help in weight management. Whatever the motivation may be that leads to smoking, the result is always the same- addiction. Quitting smoking is never as simple as starting.

Motivation plays a key role in quitting, and often is the predictor of success. Motivation behind behavior change can either be intrinsic or extrinsic. An extrinsic motivator is something external to the individual that is spawning the change. These tend to be incentives or punishments offered by a separate party. Extrinsic motivators, particularly with tobacco cessation, have not been associated with success. Intrinsic motivators are more effective in generating behavior change, as an intrinsic motivator would be internal and have value to the individual. For example, a mother may have a personal reason to lose weight such as being able to follow their toddler up and down the stairs.

With the knowledge that incentives and punishments may not be the most effective route to get employees to quit smoking, employers need to find another way to reach their employees. Programs often rely on incentives to increase awareness and participation. Incentives can still be used in this way for smoking cessation programming, however, it is important to remember their limitations and that there is no evidence that incentives actually increase quitting rates. Reasons for this may be linked to Prochaska’s[1] stages of change theory in which individuals are divided into five separate stages (pre-contemplation, contemplation, preparation, action and maintenance) describing their readiness to change a behavior. Current smoking cessation programs are successful in moving individuals already in the action stage through the behavior. However, these programs have not yet found a way to be successful in generating long-term quitting in those in the pre-contemplation, contemplation and preparation stages.

Some employers are turning to policies to get their employees to quit smoking. Again, just like with incentives, policies represent an extrinsic motivator for employees and may not generate long-term change, or drastically changing the health status and costs of the organization.

In order to generate not only immediate, but indefinite behavior change in smokers programs need to focus on the individual and provide support (Cochrane Collaborative Review). Along with policies, employers need to review what benefits are available for employees. The more access employees who are contemplating or attempting quitting have to various sources of support (nicotine replacement therapy, group programming, individual counseling etc.), the more likely they are to succeed. Employees should be educated on the policy and why it exists, and encouraged to take advantage of the resources provided to help them. Focusing on other components of health, such as physical activity, nutrition and social support also strengthens a program as well as helps to prevent relapse. Smoking is not an isolated behavior, and letting employees know their overall health status is cared about will contribute to their success, as well as to an organization’s positive and supportive environment.

[1] Glanz, K., F. Marcus-Lewis, and B.K. Rimer, editors (2008).  Health Behavior and Health Education, (4th  edition).  California: Jossey-Bass Publishers.

 Kay Monks

Kay is a senior at American University in Washington, D.C, where she is enrolled in the Health Promotion Education program. Kay has been an intern with AdvancingWellness since early 2011.



John sat at his desk, exhausted. Not being able to focus on his work that he was already behind on, he thought about how not only has he lost attention at work, but how his interest in most aspects of his life has also diminished. He realized his whole outlook had shifted. He no longer could see the positives, and could only dwell on the negatives.

John is not alone. Exhibiting symptoms of depression, he is one of approximately 18.8 million American adults who face depression each year. Depression ranks third for problems within the workplace for employees, only behind family crisis and stress, according to Mental Health America. Not only do employees report depression as a workplace issue, but depression is also something employers need to become increasingly aware of. Mental Health America calculates that untreated depression costs the United States over 51 billion dollars due to absenteeism and lost productivity.

What is depression? The National Institute of Mental Health defines depression as a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy activities for an extended amount of time. Depression is a common, and serious illness. Symptoms include those that John was experiencing; fatigue, lack of ability focus, loss of interest in activities that were once joyful, and a hopeless outlook. For a full list of symptoms associated with depression, visit In the workplace, it is especially important to take note of a decrease in consistency or productivity and quality of work, an increase in absenteeism, errors, procrastination and incidences of withdrawal.

Luckily for John, his concerned wife was able to get him to see his doctor, who identified the problem. John started medication and quickly began to improve. John’s ability to get control of his depression isn’t the exception. According to the Centers for Disease Control and Prevention, if diagnosed and treated about 80% of cases of depression can improve. Depression can be managed and employees can live a fulfilling and successful life even with this diagnosis.

Unfortunately, the negative stigma associated with clinical depression is making it hard for employees to seek treatment and disclose their diagnosis to colleagues and supervisors. Not everyone has the same support that John had, leaving them alone to handle their disease. Employees may not want to be judged or regarded any differently, and therefore keep their diagnosis to themselves, only increasing their level of stress.

Those with depression are now protected through the Equal Employment Opportunity Commission under the Americans with Disabilities Act, which expands employer’s responsibilities in making accommodations for employees with mental health disabilities as well. Employees with depression should now feel comfortable talking to their employer in order to reach a better understanding of the employee’s needs.

Employers and managers should be well versed in the Employee Assistant Programs that they offer their employees. Being familiar with the benefits available will allow employers to encourage employees to take advantage of these services.

Just like John, one out of every 10 American adults faces depression. Raising awareness among managers and employees helps to create an understanding and supportive environment for these employees. Not only could this type of positive workplace culture help to prevent depressive illnesses, it will also foster feelings of support and comfort for those already diagnosed. This allows employees to reach out, thus creating a stronger team and organization. Promoting a supportive and positive workplace environment is now more important as ever, as rates of depression continue to rise.

Kay Monks

Kay is a senior at American University in Washington, D.C, where she is enrolled in the Health Promotion Education program. Kay has been an intern with AdvancingWellness since early 2011.

According to the US Bureau of Labor Statistics, unplanned absences cost American businesses an average of 2.8 million workdays each year – equivalent to the loss of 74 billion dollars. With the costs of running a business already steadily increasing, corporations cannot afford not to address the issue of absenteeism.

Absenteeism affects businesses multi-dimensionally. Corporations are impacted financially due to absences and needing to pay employees even when they are not in the office. Costs increase due to loss of productivity, the cost of hiring temporary labor, and time and money spent on tracking absences, and recruiting and training temporary employees. It is also shown that there is a direct correlation between absences and turnover, meaning if an employee has many absences they are more likely to leave a job.

Why are employees missing so many days of work? About two thirds of employee absenteeism is due to issues other than illness, including stress, being overworked, dissatisfaction on the job, a lack committed to the workplace and insufficient challenge in their work.

However, because of broad policies around time off, there is no simple way of tracking what is specifically keeping employees out of the office. Are they not showing up because of illness, another family member’s illness, or poor health in general? It is unclear whether employees are missing work because of legitimate illnesses or other underlying issues.

The most direct way to solve the ambiguity of absenteeism is to re-write policies that distinguish why employees are taking the day off. Having a clause within time-off policies allows for easier and clearer tracking when it comes to why employees are missing work.

In order to keep employees in the office and stop them from getting into the habit of calling out, they need to be motivated and engaged. Challenging and interesting work can go a long way, however a supportive and enticing culture is needed in order to keep employees engaged. A positive environment can help alleviate other issues such as stress, dissatisfaction and lack of commitment. A workplace that promotes teamwork, support and an overall positive culture will keep employees active and energized about their job, and will reduce absenteeism.

Kay Monks

Kay is a senior at American University in Washington, D.C, where she is enrolled in the Health Promotion Education program. Kay has been an intern with AdvancingWellness since early 2011.

Worksite wellness programs are becoming the norm in corporate America.  The key to having a successful program is through the creation of a supportive environment in the workplace. As cited by an employee who has both experienced a program that was mandated and then at a later date made optional, but with tools to make it both interesting and inspiring, “ The last program we had was force-fed.  We felt like it was part of our job and not a personal choice. Now we can see management taking strides to support all of us and themselves in creating a culture of healthy living.”

Best practices in the field of worksite health promotion states one of the seven benchmarks of creating a results-oriented worksite wellness program is to create an environment that supports a culture of wellness.  Research shows one factor that heavily weighs the success of a wellness program is having senior management commitment to the experience through personal actions in leadership. This removes, to some degree, the barrier that employees put up because they feel their employer is dictating their personal life choices. The see that management is in the game along side them, also making changes that better their health and quality of life.

Wellness is not a “one-size-fits-all” initiative. Each participant has unique life circumstances, medical histories and risk factors as a result. When there is group level support as well as individualized attention to personal goals setting research shows successful programs are born.

Employers taking the first steps to be well are leaders in the initiative.  Some initiatives that have successfully aided in the transition to creating a culture of health are as follows:

  • Making the workplace smoke-free by putting into place policies that prohibit smoking on the property and implementing a smoking cessation support program
  • Wellness Challenges that engage and motivate. Each campaign centered on increasing physical activity, proper nutrition and better self-care.
  • Offering a steady stream of relevant health-related information and education to employees. This being done to promote on-going excitement and inspiration through the power of knowledge.
  • Sharing success stories and testimonials is one of the easiest ways to engage the heart of the employee that is on the fence about changing their lifestyle. It helps make possibilities real.
  • Implement healthy eating guideline policies to make certain healthful options are always made available in vending machines and all catered company functions. Companies with cafeteria offerings may consider offering a discount on all healthy meal options as well as sharing food-labeling information to encourage making healthy choices.
  • Implement an hourly over-head chime reminder to promote getting up to stretch, move or change position.
  • Start a stairwell program.

Creating an environment of support to the whole employee population, as well as the individual takes time. Each company has its unique needs.  Finding the balance is what will make it work. Happy, healthy, cared for employees have been proven to be more productive. Having a healthy workforce is a powerful tool for success. Let today be the day you take the first steps toward creating a culture of health in your workplace.

By Melissa Naborowsky, RN

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