Changing Culture - Worth the Effort!

It is amazing what can be accomplished with a few people who are invested in a cause. A year ago I embarked on a new project within my community. A friend of mine and I wanted to begin a running club for young girls. Faced with challenges, we tweaked our plan. We decided to approach the school with a larger, more robust idea - create a healthier community for our children, the staff and the community. The idea was not only embraced by our principal, but we were also given the green light to create a Council and start improving the health of our community ASAP.

It has been a year since CATENA STRONG was formed, and we are excited to have exceeded our participation and awareness goals for our first year. What is even more exciting is the momentum and excitement around this program. Given the opportunity, very busy parents and teachers will take the time be a part of something they believe in. Something that allows them to make a positive impact on their community and the environment they live in.

Lessons learned in the process:
1. Group decision making might take longer, but it affords ownership and commitment to the initiative. Long-term solution, rather than short-term impact.
2. Being part of something that is fun, and tangible is essential to create excitement within a group of volunteers.
3. Giving volunteers a specific "job" ensures empowerment and helps them know their value.
4. Ideas are great, but converting them to initiatives take time, coordination and the willingness to compromise with stakeholders in the process.
5. Volunteers usually have a preference to be a leader or not, respecting this preference is key.

The experience and impact has been incredible, and I am honored to have been able to help lead such a successful effort with a group of fantastic people. I plan to continue the effort & build on successes for greater impact. Culture change is hard, but worth the effort when you can see & feel it happening!

Health care: a problem to solve or opportunity to integrate?

Whose job is it to keep our nation healthy? In today's climate with economic cutbacks, limited resources and extended work responsibilities within all sectors, it seems that everyone agrees that everyone has a role in improving access, quality, and affordability of health care. In addition, every business, membership organization and government agency has the responsibility to provide resources to allow it's members to understand and manage their health care needs. Based on this agreement, it is surprising how challenging it is to integrate disciplines to resolve these very important issues.

Similar to organizations that are decentralized and work in silos to run their businesses, the various areas of health care have been contained within their own space for some time. From public health to school health to health promotion to health technology to health psychology and others, we have evolved within our disciplines over the years, but done a poor job learning from each other and integrating our best practices to afford greater outcomes.

Perhaps the question is not "Whose job is it to keep our nation healthy?" ,but "Who will take the lead in bridging the gaps between health disciplines to ensure the health of our nation improves?"  thus far, a single leader has not emerged, but some organizations (Robert Wood Johnson Foundation, Health Enhancement Research Organization, Health Advocates) are making significant strides in the arena. I commend the leaders working towards a united voice/approach to improve health care quality, access and affordability - many minds working together have always been better than one working alone.

Mobile Apps for Health

Would you like to use an app to book a doctors appointment just like you might do on Expedia or Travelocity? Would you like to have your health information accessible in an app so that you could access when needed (ie., blood pressure, cholesterol, BMI) at a doctor's office? Would you use an app to work with a virtual fitness trainer or weight management coach?  If you could, what type of app would you want to use for your health?

As smart phones continue to advance their functionality, consumers are being afforded more and more opportunities to "access" information and automate their traditional in-person services. Although there may be disadvantages to this remote approach, consumers and vendors alike are seeing the benefits of using mobile devices to connect with each other.  With this, what type of health app would you like to better manage aspects of your health care needs? Would it be a scheduling tool, a content tool, a tracking tool, or another type of tool?

If you are currently using one of the health apps on the market, please share your experience with me. I would be very interested in learning about your experience.

Incentives - are they the solution or the distraction in EHM?

For many years, we have been asked to demonstrate the ROI of health management programs. Specifically, identify the financial investment in employee health management programs and show the savings reaped from the investment. Recently financial incentives have been at the top of discussions because of their "power" in motivating individuals to participate in programs. Furthering this dialogue is health reform, allowing employers to increase the percent of health benefits that can be offered as incentives from 20% to 30%, and possibly 50% in the future.  Based on the state of the market and our interest in responding to the ROI request, many are asking the question "What is the best incentive to offer to engage participants and afford the best outcome in health programs?"

I would challenge those responding to that question and ask why we are trying to answer this question? In all of my experience over the years, no one program design has fit more than one company, because each company has it's own set of unique program goals, culture, leadership support, resources and policies. So, what would make us think we could identify one incentive amount, type, or design as the "gold standard." 

I think we should be asking different questions entirely: What barriers exist that are preventing people from prioritizing their health? How is the health of an employee woven into an organization's policies, performance reviews, manager evaluations, leadership commitment? What is the organization's opportunity to achieve greater performance, retention, growth, culture, etc.?  Identifying success measures and assigning value to these as a "return" is a worthy conversation. 

Finally, let's not focus all of our attention on an incentive and assume this component is the success or failure of the program. An incentive is only the "coupon" that gets you to walk in the store, let's try to achieve loyal customers and integrate programs so well that prioritizing health is easy, rewarding and an expectation within the organization's culture.

HERO - its strengths & vision to drive EHM

Yesterday I was honored to sit around the table with many thought leaders in the area of employee health management at the annual HERO Think Tank meeting. I am always impressed at the level of commitment and engagement these meetings include, as well as the "brain power" around the table. Credit should be given to the founders of HERO (Bill Witmer and Mark Dundon), as well as Jerry Noyce and his staff for continuing to evolve HERO as an organization and continue its mission. Today it was determined that HERO's research focus is to identify EHM best practices for the industry and it's members and continue to flesh these out to better define gold-standard EHM programming.

As I process our meeting, I have a few observations....

- member organizations are only as good as it's members and their ability to identify their organization's goals, define a strategy to achieve these goals, and take action on this strategy.
- effective leaders bring out the passion in people and their interests, and utilize this energy to shape and springboard the organization's mission.
- organizations should recognize their past successes, but focus on their future success and defining it well. Defining the questions they are trying to answer, determining whether the group has the means to adequately address them, and if the right people are involved to make it happen.

As I sat through research priority discussions today, I felt excited to be a part of a group that has not only identified priorities for our field, but also challenged itself to conduct research with scientific rigor, investigate areas that practitioners are most interested in, and commit to establishing partnerships with other organizations to reach their goals. In addition, it has been an outstanding experience thus far to learn from the many leaders and minds involved in this initiative.

Health Education - its importance at school

A recent study revealed that sharing BMI results of overweight and obese children with their parents had no affect on whether children lost weight years later http://www.foxnews.com/health/2011/07/08/no-point-in-telling-parents-about-kids-weight/ . Although one might think this is surprising, it coincides with our experience when only presenting individuals with their health status data, and little information on what the data means or resources/programs to work on improving such metrics. Without the latter, it can be assumed that individuals, will at a minimum, understand they have health risks, but certainly not understand the importance of those risks or how to better manage them.

Currently, I am working with a local elementary school to improve their culture of health. The goal of the initiative is to increase awareness of healthy habits throughout the community, and ultimately improve the health of the students, families and staff of the school. This study is timely, as the school has been measuring  BMI and fitness levels for all students. To date, a standard one-page report has gone home to parents letting them know of their child's results. It would be ideal to continue these health measurements, but create communication pieces that emphasize the reason for measuring these stats, the importance of managing them, and how the school is working to provide an environment supportive of healthy activities. Ultimately, the changes in policy and environment would improve student health status.

Although it is not the school's responsibility to manage the health of their students, the school environment teaches ideals. Understanding how many hours children are in school during the year, and the impact the school environment can have on children, improving school policies and environment to support healthy habits is a necessity to afford our children a healthy, prosperous life. It is exciting to see how many schools throughout the country are focusing on health as a key priority of their environment.

Managing Health is a Lifestyle, not an Activity

As a health professional working with organizations to strategically plan their health management programs, one of the greatest challenges faced is to keep their population interested and engaged in their health "programs". After all, the objective is usually to implement the most effective programs to help improve the population's health status, resulting in healthier, more productive employees. Although this objective is a sound one, we may be preventing the outcome we are working so hard to achieve - lifestyle/behavior change. Why? Simply because we are asking participants to join a "program," sign up for a "class," participate in an "event." These invitations are for one-time, temporary enrollment. They begin and end, and certainly imply that there will be another option to choose from soon. Almost like trying the weekly special or buying the latest smart phone that came out this week. These programs are not soliciting lifetime change, they are suggesting a short-term solution by design.

It is for this reason I am questioning the approach and marketing we use for our initiatives today. Perhaps we need to consider adopting an approach that more openly invites permanent change. Published studies show that long-term behavior change results when individuals work with a lifestyle coach to develop a plan to change their behavior, take small steps in the process, and work towards a specific goal over a long period of time. If this is the case, we should be approaching individuals and inviting them to make a long-term change, rather than a sign-up for short-term programs?

Furthermore, I would even suggest that asking individuals to commit to a change, rather than sign up for a program, might have greater impact and better encourage long-term success. This commitment might include individuals taking the following steps:

1. Identify one health behavior change you want to make in your life. Confirm this change is important to you and you have the ability to make the change if you committed to it.
2. Pledge that you will make this change for the next 30 days by writing this commitment on paper and sharing it with a spouse, friend or confidant who will support you in your change. 
3. Identify when you will start this new behavior and mark the calendar.
4. Determine the reward you will provide yourself when you achieve your goal, write it down on the calendar on day 30 so you are reminded to reward yourself.
5. If this change is still challenging, continue for another month. If you are ready to take on another healthy habit, repeat the process while maintaining the first change.

Although well intentioned, I believe the indirect consequences of offering programs are hindering our ability to help participants achieve long-term behavior change. The American culture craves one-stop shopping and quick fixes. Discovering a way to weave health management into this culture challenges us every day, but setting realistic expectations is the beginning of success in this area. Managing your health is a lifestyle, not an activity.