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Worksite Health Promotion: Good Programs Don't Just Happen-They're Planned!

Baun, William B. EPD, FAWHP; Pronk, Nicolaas P. Ph.D., FACSM, FAWHP

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William B. Baun, EPD, FAWHP, is manager of wellnesss program at M.D. Anderson Cancer Center in Houston, Texas where he directs the wellness operations for 16,000 employees with five other wellness coaches. He is on the Board Directors of the National Wellness Institute and serves as an Associate Editor for American Journal of Health Promotion and on the Editorial Board of ACSM Health and Fitness Journal®. He has received Fellow status with both AAHPERD Research Consortium AWHP and is ACSM Health & Fitness Director® certified. Worksite program under his management have been recognized by the Washington Business Group on Health, C. Everett Koop, Fortune Magazine and American Productivity Quality Center. He is well published and was the one of the section editors on the 2003 ACSM Health Promotional Manual.

Nico Pronk, Ph. D., FACSM, FAWHP, is the vice president of Health & Disease Management at HealthPartners health system in Minneapolis, Minnesota, with responsibility for health promotion, disease prevention and disease management programs for the health plan membership. He also is the executive director of the Health Behavior Group, a HealthPartners business unit that provides health health promotion, disease prevention and disease self management products and services to the local, national, and international wellness market. As a senior research investigator at the HealthPartners Research Foundation, he conducts studies in the areas of behavior change, population health improvement and the impact of the system-level change on health-related outcomes. Dr. Pronk has published extensively in the areas of exercise and physical activity, behavior change, economic impact of health initiatives. He is currently an associate editor for the ACSM's Health & Fitness Journal®, a member of the International editorial board of Disease Management & Health Outcomes, and an editorial board member of the CDC e-journal Preventing Chronic Disease. He is a current member of Task Force on Community Preventive Services and the Clinical Obesity Research Panel (CORP) at National Institutes of Health. Dr. Pronk received Fellow status for ACSM and the former Association for Worksite Health Promotion (AWHP).

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Program planning is a critical step in successful work site health promotion programming. Quite often, however, the challenges of day-to-day operations and the ongoing activity of existing programs do not allow for optimal planning. Programs end up being implemented with less than optimal preparation, decreasing the opportunity for success.

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At M.D. Anderson Cancer Center in Houston, Texas, the staff of five wellness coaches have designed, implemented, evaluated, and reengineered many work site health promotion programs. This column highlights some of their learning experiences and methods, and shares some insights and advice regarding program-planning processes. For purposes of illustration, physical activity is used as the topic for this program-planning process.

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Key Questions to Jump-start the Planning Process

It takes about three months to complete the preparation for the implementation of a successful program. Planning always starts with a set of questions, so let's jump right in with some questions to get you thinking about physical activity program planning for the year by using the "5-times-5" strategic planning tool.

1. What five words would you use to best describe your exercise and physical activity programming efforts? Hard to do in five words, you bet; however, keeping it simple forces you to focus on the main components of your program. Many of us will consider words like facility, variety, assessment, prescriptions, lifestyle, clubs, classes, mentors, exercise coaches, stairwells, targeting/tailoring, or high risk.

2. What five concepts are missing from your exercise and physical activity programming efforts? Many of us will consider words like stage of change, multiple-program offerings, high-risk offerings, variety, relapse prevention road maps, or reaching the hard-to-reach.

3. What five words best describe your most successful exercise and physical activity programming efforts? Force yourself to carefully choose the words that provide an instant vision (not much different from what we must accomplish in our "sound bite" email-marketing efforts).

4. What five lessons did you take away from your most successful exercise and physical activity programming effort? Use bullets to describe your learning experiences and outline them for each of the following categories: (1) registration, (2) marketing, (3) program delivery, (4) program drop outs, and (5) successful program participants.

5. After answering the four questions above and taking a look at your exercise and physical activity plans for the year, what's missing? Outline five programming concepts that would ensure that you meet your 2006 physical activity goals.

This process helps uncover the things you do well and those things you are not doing at all, and forces you to think strategically. Most programmers have good strategic intentions, but the day-to-day ongoing work is addictive and never leaves the time you'd like to do formal strategic planning.

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Next Step: Kick Start Proposal

Now, you have some program concepts and, maybe, you have one idea that sounds great, or your team has come up with several good ideas and you need a proposal process that will help you decide on your best opportunity for success. At M.D. Anderson Cancer Center, the wellness coaches put together a program-planning process that allows the team to keep the programming process moving forward with appropriate input along the way. The team uses a "Kick Start Proposal Process" where the primary programmer prepares a quick outline answering the five questions below. At a staff meeting, each programmer uses these one-page, brief, and succinct outlines to propose their ideas. After hearing all the proposals, the team has a better understanding of the strategic fit for each idea and, at the end of the meeting, the team decides what program should be initiated.

Kick Start Proposal Questions:

1. What is the major purpose of the program?

2. What is the need for this program?

3. What are the potential benefits of this program?

4. What are the 2 to 4 program goals?

5. What are the program basics?

The answers to these five questions should include descriptions of the program mix (the variety of services you will implement, including awareness, behavior change, and environmental support strategies and tactics), goals and objectives statements, metrics for measuring success, marketing ideas, delivery and implementation ideas, and the approach to evaluation.

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Program Plan: All the Details

Programs may fail because of all sorts of reasons, but the number one reason is probably poor planning, or failure to properly prepare and manage the details. It doesn't matter if you are managing a program for 150 or for 150,000 employees. The program details, in both cases, must be complete and managed in a timely, efficient, and effective manner to run a successful program. Many program managers have probably already prepared a list of program details that "might be necessary" in programs. Few programs will use everything listed, but most programs will require half of the program components planned if the program is to be successful. At M.D. Anderson Cancer Center, all wellness-programming efforts are assigned a primary and secondary programmer, and they work together as a team to prepare the plan, using the program component list in Table 1.

Table 1
Table 1
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When the Program Planning Worksheet has been completed, the next step is to put all the elements on the Program Timeline Worksheet. The team at M.D. Anderson Cancer Center suggests breaking the timeline into four phases. Table 2 illustrates a timeline designed specifically to address issues related to supportive program collaterals and materials.

Table 2
Table 2
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It is important to ensure that program evaluation not only measures program success but also helps provide the fine-tuning ideas that will make the program better the next time it is offered. Because evaluation usually gets high verbal support, but is the first process eliminated when there is just too much to do (consider being very realistic about your evaluation plans). Optimally, integrate your data collection process into the program design so that a separate evaluation process is not required. You can accomplish this by selecting a specific subprocess for more detailed evaluation. For example, registration, assessment scheduling, and celebration activities are all subprocesses that can cause major headaches and are great selections for detailed evaluation.

Most of us are focused on outcome data sets and we work hard to gather baseline data for comparison. But remember-most programs fail because of programming or implementation details that get derailed because of complexity or just being too cumbersome and inefficient. Select an evaluation process that is doable, helps the participants and the management to measure and understand program success, and helps you refine or reenergize the program in the future.

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Planning Inertia-Stuck? Web Sites Are a Good Place to Start

In the same way that writers may suffer from writer's block, program-planning efforts may get stuck. If this happens, try a variety of resources to get some ideas, thoughts, and examples based on what others have done in the past. The Internet is a great resource, and all sorts of Web sites can provide the ideas and creative insight needed to get the planning process moving.

Use the ACSM "Current Comments" http://www.acsm.org by clicking on "News," then Current Comments." This provides proactive statements issued and endorsed by ACSM concerning the exercise to help generate program ideas. Another good ACSM resource to help you generate ideas is the "Position Stands" section on the Web site (go to http://www.acsm-msse.org and click on "Position Stands"), which provides access to the official statements from ACSM concerning exercise. Both are excellent resources to help you generate programming ideas based on good science.

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Still Stuck? Try the Name Game

A good program idea-generation process to use when the staff can't seem to overcome planning inertia is the Name Game. During a team meeting, give your team several minutes to come up with five program names they really like. Don't forget that the longer time you give them, the less likely their creativity will be stimulated. When the team has heard everyone's ideas, decide on the top five ideas and start brainstorming the basics of each program. As an example, here is a list of program names to use for your next physical activity or exercise program, Name Game, session:

* Adopt a Couch Potato

* Find a Heart

* Trek for Today

* Trek for Tomorrow

* Joy Stops

* Become a Stair Master

* The All American.….

* Your Fitness-Your Way

* Buddy Up

* Exercise Bingo

* Step Up to Health

* Fitness Monopoly

* Thirty Days of Fitness

* WalkABlockALot

* Walking Wednesdays

* Spring Training

* Spring into Fitness

* Take a Break for Fitness

* Walk Out on the Job

* Walk a Mile in My Shoes

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Program Planning Takeaways

Good programs don't just happen-they're planned! And good planning includes sufficient time for the process to follow the required steps. Use the Jump Start "5-times-5" Process, the Kick Start Proposal, the Proposal Planning Worksheet, and the Program Timeline Worksheet concepts to customize a program-planning process that will work for your team. Good luck and good programming!

© 2006 American College of Sports Medicine

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