In comments before the 2009 Annual Art and Science of Health Promotion Conference, Michael O'Donnell, PhD, MPH, MBA (Editor in Chief, American Journal of Health Promotion) described rapid changes in this field and what it meant to practitioners. "Despite 4 decades of corporate health promotion as a profession, there is still no consensus as to the most effective and efficient way to render services. We have only about 3 years to get it right."
Michael offers examples: "In smoking cessation, we have good science to guide us. We know that counseling therapy or nicotine replacement medication typically yields a 10% success rate. But when we combine counseling and nicotine replacement, the rate goes up to 30%. We also know when you increase the number of minutes of counseling, you increase success rates; but at 300 minutes we reach a plateau. Involving different types of people in counseling sessions also increases the likelihood of positive outcomes. By applying these scientific principles, we multiply our success 6-fold. Yet in something like weight control, beyond knowing people need to eat less and exercise more, we have very little knowledge of what works."
Strongly believing the industry needs to dedicate itself to studying what works in health promotion, he was actively involved in promoting Senate bill (S.1001/HR2354). Called the Health Promotion FIRST (Funding Integrated Research Synthesis and Training) Act, many provisions became law when President Obama signed the Patient Protection and Affordable Care Act and began going into effect in 2010. The bill included additional health promotion provisions and enjoyed bipartisan support. Highlights include:
Development of a national health promotion plan
Increased health promotion research
Technical assistance to enhance evaluation of worksite health promotion programs
Regular surveys on worksite health program prevalence and components
Grants to pay part of the cost for comprehensive worksite health promotion programs in small organizations
Allowing employers to offer employees an insurance premium discount of up to 30% (instead of the current 20%) for positive lifestyle practices or participation in worksite health promotion programs and asking Health and Human Services to study the benefits of increasing to 50%.
Focus on What Works Best
Michael challenges practitioners to focus more on what works best in their area of expertise. "What are the most cost-effective ways to reach the greatest number of people with the most hard-hitting programs to improve their lifestyle? I realize this is difficult for individual employee health and wellness practitioners. They may have great intuition and ability to assess a person or organization, and they may develop very effective interventions to encourage change. But when you ask them why they are successful, they can't articulate the core principles critical to their success. This has been a classic problem in our field."
"I realize that practitioners dedicate a great deal of time and effort to figure out the most useful strategies for each individual and organization they serve. Unfortunately, this approach is not practical if we want to reach most employees in most workplaces. When you build cars one by one, it's not so hard to get it right. But when you build an assembly line and crank cars out at a high volume, you need to be sure the best procedures are in place to make it work. As we scale up our wellness programs, we need to draw on standardized protocols that can be tailored to the special needs of each situation."
"Practitioners need to look for opportunities to team up with the scientific community and help them develop good theories as to what works best. Learn to articulate why what you do works. We need to network and share more with people. We must test programs that have been shown to be successful and find out why they work. We don't do that nearly enough."
"Time is running out for us to get it right. The industry is growing very fast. For a while purchasers entering the market will not know the questions to ask. It will be relatively easy to sell wellness programs. But eventually purchasers will become more sophisticated and require higher levels of quality proof. As more products become available, they will push down on the price. And when they do, we must make sure these commodities offer the best possible solutions to change lives."
Growing Our Future Leaders
To meet this growth in the health promotion industry requires energetic and forward-thinking leadership. Michael is concerned that in a few years, there may be a problem finding those leaders. "For the most part, today's wellness program leaders are in their 50s. When this group entered the field in their 20s, it was a new industry with many leadership opportunities. The youngest and brightest out of grad school moved into leadership positions quickly. Unfortunately, the pool of emerging leaders to replace us is small. In the 1990s the field experienced an economic downturn. Many of the new cohort of professionals were forced to move into other lines of work to survive. These would have been the professionals to eventually fill future leadership positions, and it was a small group to begin with. I often hear managers say it's difficult to find qualified people with 15-20 years experience."
Michael expresses concerned about the consequences of this looming leadership vacuum. "If new leaders don't come from within our field, they will come from outside the field. It's wonderful to gain new perspectives, but will they have the same philosophical value we have to help people? I worry that they will be oriented more toward medical healthcare cost containment and making money. What has been unique about our field is the focus on quality of life. That is a value we must preserve. We need to continue this dialogue on growing our future leaders."
"Don't get me wrong; talent must prevail. We don't want to coddle people or they won't be able to stand the pressure of a leadership position. It's got to be survival of the fittest, and emerging leaders need to challenge existing leaders for control. Cultivate the qualities in yourself and others that you expect to see in any leader. Create a vision and put a plan in place to achieve that vision."
What if We Don't Get It Right?
When asked about the consequences of not getting it right, Michael predicts, "We have a golden opportunity right now. The Obama administration and Congress are very interested in wellness and prevention. Prevention is the only thing that is not controversial. Congress believes prevention is the magic bullet to fix healthcare. But if we don't develop programs that produce consistent positive outcomes, we'll be in trouble. We have less than 3 years to get it right or we will lose the credibility we've worked so hard to achieve. If that happens, government and employers will shrug their shoulders and say, 'We tried, but it didn't work.'"
And Michael isn't sure who (or what) will fill the vacuum if it doesn't work. "It's kind of like managed care. In the original closed panel approaches developed by two of the larger HMOs, managed care produced better health outcomes at lower prices. This mutated into PPO approaches which are basically bulk purchasing arrangements that lack internal quality or cost controls. Managed care got a bad name. I think something similar could happen to worksite health promotion if we don't take action now."
Dean Witherspoon, CEO and founder of employee wellness firm, Health Enhancement Systems, has 25 years in health promotion. He has served on the board of the Association for Worksite Health Promotion and held several regional as well as state offices. Dean is a nationally known speaker and author, having presented at more than 70 conferences and written hundreds of employee wellness articles for national publications.
Michael offers examples: "In smoking cessation, we have good science to guide us. We know that counseling therapy or nicotine replacement medication typically yields a 10% success rate. But when we combine counseling and nicotine replacement, the rate goes up to 30%. We also know when you increase the number of minutes of counseling, you increase success rates; but at 300 minutes we reach a plateau. Involving different types of people in counseling sessions also increases the likelihood of positive outcomes. By applying these scientific principles, we multiply our success 6-fold. Yet in something like weight control, beyond knowing people need to eat less and exercise more, we have very little knowledge of what works."
Strongly believing the industry needs to dedicate itself to studying what works in health promotion, he was actively involved in promoting Senate bill (S.1001/HR2354). Called the Health Promotion FIRST (Funding Integrated Research Synthesis and Training) Act, many provisions became law when President Obama signed the Patient Protection and Affordable Care Act and began going into effect in 2010. The bill included additional health promotion provisions and enjoyed bipartisan support. Highlights include:
Development of a national health promotion plan
Increased health promotion research
Technical assistance to enhance evaluation of worksite health promotion programs
Regular surveys on worksite health program prevalence and components
Grants to pay part of the cost for comprehensive worksite health promotion programs in small organizations
Allowing employers to offer employees an insurance premium discount of up to 30% (instead of the current 20%) for positive lifestyle practices or participation in worksite health promotion programs and asking Health and Human Services to study the benefits of increasing to 50%.
Focus on What Works Best
Michael challenges practitioners to focus more on what works best in their area of expertise. "What are the most cost-effective ways to reach the greatest number of people with the most hard-hitting programs to improve their lifestyle? I realize this is difficult for individual employee health and wellness practitioners. They may have great intuition and ability to assess a person or organization, and they may develop very effective interventions to encourage change. But when you ask them why they are successful, they can't articulate the core principles critical to their success. This has been a classic problem in our field."
"I realize that practitioners dedicate a great deal of time and effort to figure out the most useful strategies for each individual and organization they serve. Unfortunately, this approach is not practical if we want to reach most employees in most workplaces. When you build cars one by one, it's not so hard to get it right. But when you build an assembly line and crank cars out at a high volume, you need to be sure the best procedures are in place to make it work. As we scale up our wellness programs, we need to draw on standardized protocols that can be tailored to the special needs of each situation."
"Practitioners need to look for opportunities to team up with the scientific community and help them develop good theories as to what works best. Learn to articulate why what you do works. We need to network and share more with people. We must test programs that have been shown to be successful and find out why they work. We don't do that nearly enough."
"Time is running out for us to get it right. The industry is growing very fast. For a while purchasers entering the market will not know the questions to ask. It will be relatively easy to sell wellness programs. But eventually purchasers will become more sophisticated and require higher levels of quality proof. As more products become available, they will push down on the price. And when they do, we must make sure these commodities offer the best possible solutions to change lives."
Growing Our Future Leaders
To meet this growth in the health promotion industry requires energetic and forward-thinking leadership. Michael is concerned that in a few years, there may be a problem finding those leaders. "For the most part, today's wellness program leaders are in their 50s. When this group entered the field in their 20s, it was a new industry with many leadership opportunities. The youngest and brightest out of grad school moved into leadership positions quickly. Unfortunately, the pool of emerging leaders to replace us is small. In the 1990s the field experienced an economic downturn. Many of the new cohort of professionals were forced to move into other lines of work to survive. These would have been the professionals to eventually fill future leadership positions, and it was a small group to begin with. I often hear managers say it's difficult to find qualified people with 15-20 years experience."
Michael expresses concerned about the consequences of this looming leadership vacuum. "If new leaders don't come from within our field, they will come from outside the field. It's wonderful to gain new perspectives, but will they have the same philosophical value we have to help people? I worry that they will be oriented more toward medical healthcare cost containment and making money. What has been unique about our field is the focus on quality of life. That is a value we must preserve. We need to continue this dialogue on growing our future leaders."
"Don't get me wrong; talent must prevail. We don't want to coddle people or they won't be able to stand the pressure of a leadership position. It's got to be survival of the fittest, and emerging leaders need to challenge existing leaders for control. Cultivate the qualities in yourself and others that you expect to see in any leader. Create a vision and put a plan in place to achieve that vision."
What if We Don't Get It Right?
When asked about the consequences of not getting it right, Michael predicts, "We have a golden opportunity right now. The Obama administration and Congress are very interested in wellness and prevention. Prevention is the only thing that is not controversial. Congress believes prevention is the magic bullet to fix healthcare. But if we don't develop programs that produce consistent positive outcomes, we'll be in trouble. We have less than 3 years to get it right or we will lose the credibility we've worked so hard to achieve. If that happens, government and employers will shrug their shoulders and say, 'We tried, but it didn't work.'"
And Michael isn't sure who (or what) will fill the vacuum if it doesn't work. "It's kind of like managed care. In the original closed panel approaches developed by two of the larger HMOs, managed care produced better health outcomes at lower prices. This mutated into PPO approaches which are basically bulk purchasing arrangements that lack internal quality or cost controls. Managed care got a bad name. I think something similar could happen to worksite health promotion if we don't take action now."
Dean Witherspoon, CEO and founder of employee wellness firm, Health Enhancement Systems, has 25 years in health promotion. He has served on the board of the Association for Worksite Health Promotion and held several regional as well as state offices. Dean is a nationally known speaker and author, having presented at more than 70 conferences and written hundreds of employee wellness articles for national publications.
