Aligning Program Support With Interventions for Optimum Impact.
Nico Pronk, Ph.D., FACSM, FAWHP, is executive director of the Health Behavior Group and vice president of Health and Disease Management at HealthPartners health system, which provides health promotion, disease prevention, and disease management services for worksites and health plans around the country. Dr. Pronk has published extensively in the health-related scientific literature and is currently an Associate Editor for ACSM's Health & Fitness Journal1and an Editorial Board member of CDC's Preventing Chronic Disease e-journal. Among other public services activities, he currently serves on the Task Force on Community Preventive Services supported by CDC and the Interest Group on Worksite Health Promotion at ACSM. Dr. Pronk received Fellow status for ACSM and the former Association for Worksite Health Promotion (AWHP).
The implementation of every worksite health promotion program calls for a set of programmatic solutions or interventions (you may call these programs, services, the "program mix," etc.) that provide the options, choices, and resources employees may select from as they participate in the program. As part of a well-designed program, these interventions tend to be a reflection of a set of actions taken by the worksite health promotion staff that include analyses of current health status among employees, health care expenditures, willingness and interest of employees to take action and participate in health improvement services, functional status, and perhaps even productivity metrics that reflect worker performance, among others. These interventions also need to be implemented in a supportive context to allow for positive results to be generated. This context is certainly reflective of a "supportive environment" for health promotion but also includes processes and procedures that will allow for successful implementation of worksite health promotion programs. In a sense, it combines a variety of best practice guidelines with best program solutions to optimize outcomes and likelihood for success.
What Do We Know About Best Practices?
Over the years, several benchmarking or best practices projects and studies in worksite health promotion have been conducted. Three best practices projects are of particular interest to this column because they were comprehensive efforts that used sound methods and reflected, to some degree, changes over time (1-3). In 1997, M. O'Donnell and colleagues (1) published the results of a best practices study based on identification of "excellent" programs. In 1998, R. Goetzel and associates (2) published their project that was designed as a benchmarking study based on site visits to seven organizations. More recently, in 2004, L. Chapman (3) published an "expert opinion" article that presented best practices as derived from a formal polling effort of both academic and practitioner experts. An interpretation and summary of the consistent results of these "best practices" is provided in the Table.
What Do We Know About Best Program Strategies?
Alongside the key dimensions in the Table, core best practice components represent the heart of program strategies. Typically, the program strategies are thought of at a more actionable level than the dimensions and include aspects of program planning, design, implementation, assessment, evaluation, reporting, and so on. As such, these strategies are inclusive of interventions as witnessed by the presence of the following practices noted in the "best practices component" column of the Table:
* Targeted personalized messaging
* Announcements and updates at staff meetings
* Effective incentive programs
* Multilevel program development
More detail around the design of interventions can be found in the program development and incentive programs components. Intervention program design and development includes identification of programs that generate outcomes, a program mix that reaches all employees-regardless of risk level-and can support individual health needs. They also are scalable over time and integrate behavior change models such as the stages of change construct and the self-efficacy concept that are sustainable over time to allow for adoption and maintenance of new behaviors for employees (4).
Why Is Alignment Between Program Support and Intervention Strategies Important?
The best practice approach allows for a worksite health promotion initiative to be implemented with the support of the appropriate resources, leadership and management structure, data management techniques, and mechanisms that address scalability and sustainability. Not only is this important in the context of ensuring proper implementation but also to ensure ongoing reporting, continued investment, and establishing a trail of program impact, success, and accountability. Merely implementing a variety of interventions without connecting to the larger organization does not follow a sustainable model. Before long, the budget supporting such activity will be in jeopardy, and the program will fall victim to haphazard implementation, poorly planned activities, and constant scrutiny because quality outcomes will be difficult to demonstrate.
Alignment between program support structures and interventions will ensure that the highest level of leadership is updated in a timely manner on program performance and that, through appropriate performance measurement, those responsible for the program receive feedback. In addition, the perceived value of the worksite health promotion program will be higher when a direct relationship is observed between the health of the employees and the core products of the company. However, this involves more than merely linking program and business goals through statements-such linkages and connections must be made explicit through quantification of the outcomes, translated into financial and business terms and measures. The Figure presents a depiction of the relationships discussed in this column.
Measuring Best Practices
To date, few resources are available to measure whether a company is successful in following best practices. Recently, however, the Health Enhancement Research Organization (HERO) developed a Best Practice Scorecard that outlines the critical core components to what constitutes an exemplar health management program and provides a method for practitioners to self-score their program using a predefined scoring mechanism-the Scorecard (5). Some of the core components include executive commitment, corporate culture, participation rates, integration, communication, incentives, health assessment, intervention, and documentation of outcomes. The Scorecard has two sections: the Best Practice Core Components and the Key Outcomes-Benchmarks sections. Using a set of definitions linked to a score, the tool assigns points to each question for both sections, and the total number of points may be interpreted according to a simple comparison to comprehensive programs that have been operational for less than 3 years or for 3 years or more. The HERO Health Management Best Practice Scorecard is available via the HERO Web site at www.the-hero.org and may be downloaded for self-administration. For those worksite health promotion practitioners who are interested in monitoring their program against best practice criteria, the HERO Scorecard is a useful tool to apply a measurement set against the program and monitor progress over time by repeating the completion of the scorecard every year.
1. O'Donnell, M., C. Bishop, and K. Kaplan. Benchmarking best practices in workplace health promotion. The Art of Health Promotion Newsletter
2. Goetzel, R., A. Guindon, L. Humphries, et al. Health and Productivity Management: Consortium Benchmarking Study Best Practice Report. American Productivity and Quality Center International Benchmarking Clearinghouse, Houston, TX 1998. (www.apqc.org
3. Chapman, L. Expert opinions on "best practices" in worksite health promotion (WHP). The Art of Health Promotion Newsletter
July/August 2004, 1-6.
4. Pronk, N.P. Designing and evaluating health promotion programs. Simple rules for a complex issue. Disease Management and Health Outcomes