Changing the Work Environment to Make the Healthiest Choice the Easiest Choice

Transcription

1 Changing the Work Environment to Make the Healthiest Choice the Easiest Choice Richard Safeer, MD Medical Director, Employee Health & Wellness Johns Hopkins HealthCare, LLC Assistant Professor of Pediatrics and General Internal Medicine Johns Hopkins University, School of Medicine Assistant Professor of Health, Behavior and Society Johns Hopkins University, Bloomberg School of Public Health

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4 Organizational Structure Johns Hopkins Health System (JHHS) Johns Hopkins University (JHU) Johns Hopkins Medicine The Johns Hopkins Hospital Johns Hopkins Bayview Medical Center Johns Hopkins Community Physicians Howard County General Hospital Suburban Hospital, & Healthcare System Sibley Memorial Hospital All Children s Hospital & Health System School of Medicine Schools Not Part of JHM Legal Entity Unincorporated board of division Johns Hopkins HealthCare LLC Johns Hopkins Home Care Group JH Ventures, LLC Johns Hopkins Medicine International, LLC 4 4

5 Objectives Participant will be able to cite at least three ways to measure environmental change Participant will leave having at least one idea of how to measure the effort at their organization Participant will understand two ways to position measurement tools such that these tools help create change 5

6 Factors That Affect Health Dr. T. Frieden, CDC. AJPH

7 Promising Practices in Employer Health and Productivity Management Efforts: TABLE 1 Findings From a Benchmarking Study Summary of Previous Benchmarking Best Practice Studies HPM Best Practice Goetzel et al, 1997 APQC O'Donnell et al, 1996 IHPM Goetzel et al, 1998 WELCOA Koop Health Project, Goetzel et al, 2001 Organizational commitment Program linked to business objectives Effective communication Effective operation plan Supportive environment Program goals include productivity and morale Employee input when developing goals and objectives Management leads by example Interdisciplinary team focus Identification of wellness champions Incentives to participate Program accessibility Effective screening and triage State-of-the-art interventions Effective implementation Ongoing program evaluation Data collection, measurement, reporting, and evaluation (including ROI) R. Goetzel, Ph.D. et al, J Occup Environ Med. 2007;49:

8 Healthy Beverage Initiative 8

9 Healthy Beverage Dashboard Meetings/ Events Vending Retail Cafeterias All Children s Bayview Home Care Howard County JHHC JHHS/JHMI JHU SOM SON SPH Sibley Suburban Not applicable Completed In progress Not started 9

10 Diffusion of Innovation 10

11 Healthy Beverage Dashboard Meetings/ Events Vending Retail Cafeterias All Children s Bayview Home Care Howard County JHCP JHMMC JHHC JHH JHU (Homewood) SOM SON SPH Sibley Suburban 11

12 Institutional Support JHM Five Year Strategic Plan 12 12

13 Presented by: 3/22/2017 Measurement

14 Measuring Environmental Change Process Measurement Organizational Assessment Tools Outcome Measurement 14

15 Organizational Assessment Tools Presented by: 3/22/2017

16 Assessment Tool: HERO Strengths - Can be used as a baseline inventory - Can compare scores over enterprise - Can compare score with national average and make year to year comparisons Limitations - Hidden fees - Subjective Questions: - Ex: Taken altogether, how effective is the strategic planning process? - A. Very Effective - B. Effective - C. Not very effective - D. Not at all effective 16

17 Assessment Tool: Wiscore Strengths - Definitions for each question - Comprehensive and includes best practices Limitations - Benchmarks based on 2012 responses. - No indication of demographics - Require data components difficult to capture - Helpful for employers that already have wellestablished wellness programs and need to assess impact 17

18 Assessment Tool: WorkHealthy America Assessment Strengths - The 125 indicators are aligned with the socio-ecological model to measure policies, benefits, and environments that affect employee health - Every question is weighted according to the strength of evidence (1-3 point scale) Limitations - Additional costs for access to an online toolbox with items such as surveys assessing their health and wellness policies, reports, environment al materials, etc. - Narrow scope 18

19 CDC Worksite Health ScoreCard Strengths - Can be used as a baseline inventory - Can separate the ScoreCard into individual health topics - Evidence based and comprehensive - No quantitative data required - No fees - Minimal IT resources needed Limitations - Tool recommends giving zero if question n/a - Entity can only submit one scorecard - Could not compare one JHM entity with another 19

20 Overview of the CDC Worksite Health ScoreCard Tool to help employers assess whether or not they have implemented evidence based health promotion interventions and strategies to prevent chronic medical conditions such as: Heart disease Stroke Hypertension Diabetes Obesity CDC Worksite Scorecard. < Accessed: August 5,

21 Socio-Ecological Model Meador A, Lang JE, Davis WD, Jones-Jack NH, Mukhtar Q, Lu H, et al. Comparing 2 National Organization-Level Workplace Health Promotion and Improvement Tools, Prev Chronic Dis 2016;13: DOI: 21

22 Scoring Methodology= Evidence + Impact Estimated impact on health behaviors or outcomes The best strategies are those that receive a score of 3 on the HSC tool, indicating that they have a large impact on health behaviors or outcomes and strong evidence base to support that impact 22

23 Sample Questions 23

24 Integration of Scorecard with Changing the Context 3/22/2017 3/22/

25 Why the CDC ScoreCard? Each entity can establish a baseline measurement and track progress over time The scorecard can act as a cross comparison tool across the entire enterprise and against benchmarks Roadmap for discussion among leadership Each entity can use the scorecard to guide their planning (some entities want to move more quickly than others and are looking for direction) The right price! 25

26 Measurement Tools Can Help Create Change Presented by: 3/22/2017

27 Promising Practices in Employer Health and Productivity Management Efforts TABLE 1 Summary of Previous Benchmarking Best Practice Studies Goetzel et al, 1997 APQC O'Donnell et al, 1996 IHPM Goetzel et al, 1998 WELCOA Koop Health Project, Goetzel et al, 2001 HPM Best Practice Organizational commitment Program linked to business objectives Effective communication Effective operation plan Supportive environment Program goals include productivity and morale Employee input when developing goals and objectives Management leads by example Interdisciplinary team focus Identification of wellness champions Incentives to participate Program accessibility Effective screening and triage State-of-the-art interventions Effective implementation Ongoing program evaluation Data collection, measurement, reporting, and evaluation (including ROI) Goetzel, Ph.D. et al, J Occup Environ Med. 2007;49:

28 2016 Strategic Objectives for JHM Create a healthy work environment as defined by the CDC Scorecard: 0 Scorecard not completed -- Scorecard completed by employer by December 31, 2015 Scorecard validated by People Pillar healthy workforce project team by March 31, Scorecard completed, validated and entered into CDC website by May 31,

29 Scorecard Reliability Across JHM People Pillar healthy workforce project team has a process to ensure inter-rater reliability for each of the CDC scorecard sections: Internally review every question to clarify meaning and interpretation discrepancies Provide completion directions to respondents Require documentation on certain questions that assign a high point value Meet with respondents to validate completed scorecard 29

30 JHM Results: Total Scores Total Points Possible Industry-Specific Benchmark Large Employer Benchmark JH Medicine Average

31 JHM Results: Topic Area Rankings Johns Hopkins Medicine Topic Areas, Ordered Highest to Lowest (by Percentage of Points Earned) JHM Average as a Percentage of Possible Points % Difference from Large Employer Benchmark % Difference from Industry Benchmark Vaccine-Preventable Diseases (VPD) 91.7% 6.1% 5.0% Tobacco Control 84.6% 1.0% 9.4% Stress Management 82.7% 6.3% 21.3% Emergency Response to Heart Attack and Stroke 81.9% 7.2% 8.9% Occupational Health and Safety 80.7% -2.5% 1.6% Lactation Support 78.3% 11.7% 21.0% Weight Management 72.9% -5.4% 16.3% High Cholesterol 66.7% 0.7% 14.0% Organizational Supports 65.2% -4.2% 8.5% Depression 64.4% -3.4% 14.4% Diabetes 64.4% -12.2% 5.1% Physical Activity 61.8% -5.7% 16.8% High Blood Pressure 60.3% -7.9% 6.2% Signs and Symptoms of Heart Attack and Stroke 35.4% -14.6% -4.6% Nutrition 25.4% -27.0% -10.3% *Percentages in green are higher than JHM average percentages, while those in red are lower 31 31

32 FY2017 JHM People Pillar Strategic Objectives Complete the CDC Scorecard with the total points interpreted as follows: For entities who have a baseline score below total points (out of a total 264 points, CDC benchmark) CDC Scorecard Achieve additional points on the CDC Scorecard and validated by Healthy Workforce team by April 15, 2017.* Total score says the same or decreases Total score increases 1-5 points Total score increases 6-10 points Total score increases 11 or more points For entities who have a baseline score above total points (out of a total 264 points, CDC benchmark) CDC Scorecard Achieve additional points on the CDC Scorecard and validated by Healthy Workforce team by April 15, 2017.* Total score says the same or decreases Total score increases 1-4 points Total score increases 5-8 points Total score increases 9 or more points * Entities will be provided leeway when there are parts of questions pertaining to the physical environment that are not applicable. For example, when a facility does not have a cafeteria, the entity will not be judged for a cafeteria. However, questions that specifically ask for resources, like a lactation room, need to be present to receive 32

33 Process and Outcome Measurement Presented by: 3/22/2017

34 CDC Best Practices 34 34

35 Process Measurement Meetings/ Events Vending Retail Cafeterias All Children s Bayview Home Care Howard County JHCP JHMMC JHHC JHH JHU (Homewood) SOM SON SPH Sibley Suburban 35

36 Process Measurement: Inter-Rater Reliability Tool 36 36

37 Outcome Measurement: Vending Pre/Post Sales Data Strategy Percentage of beverages in pre and post intervention (units sold) Red Beverage Availability Green Beverage Availability Size Limitation Price Differential Product Placement 20% of total offerings 60% of total offerings 12oz./container of red beverages Red beverages $.25 higher than yellow/green beverages Place green beverages at eye level Distribution of units sold, by color UNITS SOLD Pre (average) Post (average) Green 26% 53% Yellow 17% 9% Red 57% 38% Sample size: 16 beverage vending machines (out of 67 total) Access: employees and patients/visitors Pre-transition dates: February-April 2013 Post-transition dates: July-September

38 Process and Outcome Measurement Virtual Coaching/ Education In Person Coaching/ Classes OTC & RX Coverage Personal Appearance Tobacco Free Campus Garage/ Parking Lots Sale and/or Advertise ment Comfort Features/ Receptacles Insurance Premium Differential CDC Scorecard Score (Max= 19) % of Tobacco Users Method of how % of tobacco users is collected All Children s * % T (Saliva)* Bayview % S Home Care 15 11% S Howard County 17 JHMMC 19 S JHHC 19 S JHH 14 14% S JHU 18 Sibley 14 Suburban 15 * Testing was voluntary and 340 employees (10%) were tested and 16 tested positive. 38

39 Outcome Measurement 39 39

40 Conclusion Measuring Environmental Changes Organizational Assessment Tools Process Outcomes Measurement Tools Creating Change Diffusion of Innovation Linking Tool to Strategic / Business Objectives 40