Starting with their staffs, hospitals promote healthy choices

November 15, 2011

By JULIE MINDA
Part 2 in a series on the ministry's response to the U.S. obesity epidemic

Just because people work in the health care field does not mean they are healthy.

An August report from Thomson Reuters said that hospital employees and their dependents "had an 8.6 percent greater illness burden than the U.S. workforce at large and were more likely to be diagnosed with chronic medical conditions." The study found hospital employees were 31 percent more likely to be admitted to the hospital for conditions related to obesity and overweight than was the average U.S. worker.

It's no wonder then that many ministry facilities exploring how to reduce the prevalence of obesity and promote healthy behaviors in their communities are trying to get their own house in shape first.

"We're starting with our workforce first because we know that we can't look others in the eye and say that they need to be healthier if we haven't done so ourselves first," said Lynn Britton, president and chief executive of the Mercy health system based in Chesterfield, Mo.

Mercy launched Healthification, a comprehensive employee wellness effort in the spring. The program encourages employees to make healthy choices when it comes to nutrition, physical activity and their emotional and spiritual well-being.

Dr. Lance Luria, Mercy's health and wellness vice president and medical director, compares the effort to improve the health of Mercy's 38,000 employees across four states through education and incentives to moving "a giant aircraft carrier — but we're putting our resources behind this because … we want to create this healthy environment."

Attention all snackers
Ministry facilities are developing a wide variety of approaches to encourage employees to achieve and maintain healthy weights and fitness levels. Many, including Mercy, are drawing upon their dieticians, fitness experts and exercise enthusiasts to create programs that include incentives for better nutrition and increased exercise.

Among the approaches:

  • Mercy Medical Center of Cedar Rapids, Iowa; St. Mary's Regional Medical Center of Lewiston, Maine; and Saint Joseph Mercy Ann Arbor of Ypsilanti, Mich., removed the deep fryers from their cafeteria kitchens. St. Joseph Manor of Brockton, Mass., stopped cooking with oil containing trans fats.
  • Facilities within St. Joseph Health System of Orange, Calif., are offering more vegetarian choices in their cafeterias as an alternative to meat consumption.
  • Numerous Catholic health organizations host on-campus farmers' markets for employees and the public.
  • Some offer exercise challenges and facilities for employees. Providence Portland Medical Center of Portland, Ore., for example, has secure parking for bicycle commuters and it issues fitness challenges like the 5-5-5 challenge (five people, five weeks, 5,000 minutes of exercise).
  • Ascension Health's Michigan region provides intensive healthy lifestyle support to employees with multiple chronic illnesses, including weight-related conditions.

Uphill slog
Health providers know well the potential health consequences and costs of obesity, but that doesn't make weight control any easier for clinicians.

A May 2008 report in the Journal of the American Academy of Nurse Practitioners found that almost 54 percent of the 750 registered nurses who responded to a survey were overweight or obese. More than 50 percent of the overweight nurses said they lacked the motivation to make lifestyle changes; 40 percent said they were unable to lose weight despite efforts to do so; and the remainder said that they were comfortable and not interested in weight reduction.

Raquel Dominguez, who directs volunteer services and wellness initiatives at St. Francis Medical Center in Lynwood, Calif., said that while it may seem counterintuitive that nurses — who are on their feet and on the go for much of their working day — would be heavy, her informal discussions have revealed that many nurses turn to junk food to relieve their hunger. Their physical activity does not always counterbalance the calorie intake.

Heavy costs
It can cost plenty to have a hefty workforce. A Duke University study published last year estimated that obesity among full-time employees costs the nation's employers $73.1 billion annually in medical expenditures, lost productivity and absenteeism. The National Bureau of Economic Research has reported that medical expenditures are on average $732 higher annually for obese people than for people in the optimum weight range for good health.

Mercy's Luria noted that obesity's costs aren't just measured in dollars and cents, but also in terms of employees' emotional well-being, since stress, depression and other emotional concerns can be correlated with obesity. "It's a huge problem and we as health care workers need to grab the bull by the horns," Luria said.

Small steps
Even in fitness-conscious Colorado, more than one in five people are obese. That state has the nation's lowest obesity rate, says the Trust for America's Health and the Robert Wood Johnson Foundation. Colorado's obesity rate has more than doubled since 1995.

Centura Health of Englewood, Colo., which has 13 hospitals and a network of other services in Colorado, is trying to stem that trend with Code You, a wellness program that provides healthy living information to employees and tries to persuade them to get started with small steps.

Employees interested in weight management don't have to go to the gym seven days a week; they can start with brief, brisk walks and build from there, said Pam Nicholson, Centura senior vice president of strategic integration.

At the heart of Code You are 150 or so peer volunteers who coach and encourage their colleagues. The "champions" spread the word about free health screenings on campus. At town hall-style meetings, at information tables by the cafeteria and in articles in Centura publications, they talk to their colleagues about setting attainable health goals. They point them towards a Code You intranet site with tips on how to get and stay healthy.

Code You has created a lot of buzz, Nicholson said. "It has taken off like crazy. Ideas (for healthy living) are coming up from all around Centura." Employees tell Nicholson they like Code You because it focuses on achievable health goals.

Stick-to-itiveness

In Arkansas, a state where almost one out of three adults is obese, culture change is a formidable challenge. At Mercy Health System of Northwest Arkansas, in Rogers, Ark., more than 60 percent of the staff is overweight, obese or extremely obese according to data that employees self-report on a health risk assessment. Mercy Rogers created a formal employee wellness initiative in 2008, but only about 10 percent to 15 percent of Mercy Rogers' workforce chooses to participate in the wellness program at any given time.

The facility has added healthy eating options at its cafeteria, including burgers made of leaner meat, and issued a president's fitness challenge among other promotions.

This spring, Mercy Rogers' program was bolstered by its parent company's launch of Healthification. Courtney Guppy, Mercy Rogers' senior consultant on benefits and wellness, said it's never easy to motivate people to change their behaviors. "Finding the programming in which coworkers will want to participate takes time. I have found wellness (programming) to be a lot of trial and error."

She remains optimistic though that over time, with consistent health messaging and support for behavioral change, a cultural shift can occur. "You can't make (employees) do anything nor should you want to tell everyone how to live their life. But if you just keep them informed and constantly communicate with them, it's just like advertising, and they start to tune in."

And Guppy is seeing some signs that the healthy lifestyle messages are starting to take root. Some employees have told her they're breaking unhealthy habits. Groups of coworkers have joined Weight Watchers. Guppy is seeing new faces at the health events Mercy Rogers publicizes in-house, like the Bentonville, Ark., Running Festival. Also, Mercy Rogers saw a 2 percent decrease in health insurance usage last year that leaders attributed in part to wellness programming, said Guppy.

When it comes to the wellness programming, she said, employees "know it's there, they can choose it if they want to, but it's ultimately up to them."


Mercy's Healthification offers employees incentives to get fit

Mercy is aiming to help its 38,000 employees get or stay fit through a systemwide wellness effort it launched this spring.

The Healthification initiative provides associates with information on how to make healthy choices when it comes to diet, fitness, smoking and work-life balance. Mercy tapped the expertise of its own health care workforce, as well as that of outside experts, to develop the program.

Also, Mercy's facilities are improving the health food selection on campus. For instance, the grill at St. Joseph's Mercy Health Center serves turkey bacon and turkey sausage. (Employees at the Hot Springs, Ark., hospital can still go to the cafeteria for a selection that includes some less healthful fare.)

On Mercy's Healthification intranet site employees can design a healthy eating plan, track their calorie intake and complete short web courses on health topics. The website includes a physical activity tracker. Employees who complete a web course and those who track their activity are entered into drawings for $100 gift cards and other rewards. Employees insured under Mercy's medical plan can report their participation in a disease-management program and receive rewards of up to $300 for 12 months in such programs and for completing certain health goals.

Individual facilities can experiment with what works with their workforce. Mercy employees who serve as wellness coordinators in every Mercy region meet weekly by phone to share how well their approaches are working. They also publicize their efforts on Mercy's intranet.

For the nutrition portion of Healthification, Mercy used a food scoring system from the NuVal company in Braintree, Mass. The scoring system rates the nutritional value of different foods. Mercy provides this information to associates on its intranet site, and they can access it on NuVal's internet site. The system uses a mathematical formula to weigh 30-plus nutrition factors and come up with a single rating of a food's healthfulness. Scores range from 1 to 100 — the higher the score, the better the nutrition.

Some sample scores:

  • Broccoli 100
  • Blueberries 100
  • Spinach 100
  • Bananas 91
  • Grapes 91
  • Atlantic salmon 87
  • Almonds 81
  • Two percent milk 55
  • Skinless chicken breast 39
  • Cashews 25

Additional nutrition information is available at nuval.com.


It can be challenging to measure wellness programs' success, say experts

Ministry systems and facilities want to ensure their efforts to improve employee health and reduce obesity are having an impact. But, it can be difficult to determine how to measure that impact, according to ministry members who work with employee wellness programs.

Pam Nicholson, senior vice president of strategic integration for Centura Health of Englewood, Colo., said difficulties arise in determining what data to collect and how, and in establishing a baseline and goal for changes.

When it comes to health outcomes, that system now is allowing employees to self-report their progress on self-established goals for a wellness initiative called Code You that Centura launched a year ago. Employees serve as Code You health champions — talking with their colleagues about adopting healthy lifestyles, keeping them informed of opportunities to improve their health and circulating healthy recipes, wellness tips and other resources.

In time, Centura may develop a way to capture data on health outcomes that goes beyond the employees' self-reporting. Centura also may watch employee absenteeism statistics — the system expects absenteeism to go down — and will monitor medical claim information, as it expects the number of claims will decrease as employees' health improves.

Mercy health system in Chesterfield, Mo., also is evolving how it measures the success of its employee wellness program, which it calls Healthification. It plans to watch its employee health plan statistics and expects to see its costs to ensure employees decrease. It also plans to use surveying to determine how well the program is working for employees. As with the Centura program, Mercy employees can self-monitor their progress toward their individual goals; they can use online tracking tools provided by Mercy.


Ethical considerations for employee obesity programs

When establishing wellness programs for employees — and particularly when establishing obesity-related programs — ministry systems need to be aware of some potential ethical pitfalls, said Ron Hamel, CHA senior director of ethics.

A key concern is that the system or facility not come across as stigmatizing unhealthy employees, or as blaming them for their condition, said Hamel. Instead, the facility should be encouraging, celebrating employees' health accomplishments and incentivizing them to do even better.

Another potential concern is determining where to draw the line in how far to take the monitoring of employee health, said Hamel. With some health care providers already saying they will not hire smokers, how might this type of policy be applied to obesity, he wondered. It will be important when determining policies and programming related to obesity to respect employees' and applicants' dignity, Hamel said.

 

Copyright © 2011 by the Catholic Health Association of the United States
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