AHA: Hospitals should create a 'culture of health' for HCWs

Set clear, measurable EH program goals

It's time for hospitals to stand up for the health and wellness of their own.

The American Hospital Association has issued a call to action for hospitals to embrace wellness and health promotion for their employees.

"[Wellness] is an important piece of what we do as health care organizations," says Maulik S. Joshi, DrPH , senior vice president of research for the AHA in Chicago. "You've got to be a role model [for the community]."

While hospitals are increasingly embracing the mission of wellness for their employees, outcomes-oriented programs are rarer, according to an AHA-sponsored survey of 876 hospitals, conducted in 2010. The report and survey were coordinated by the AHA's Long-Range Policy Committee.

About three out of four hospitals offer the basics: Weight loss, smoking cessation, healthy food options, health risk assessments, the survey found. But only 47% have biometric screenings, such as cholesterol and blood pressure, and only 37% offer personal health coaching to help employees alter their habits and lifestyles.

"We have been good at the initial triage, the assessment of where we all are," says Joshi. That's an important first step, he says. But it needs to be followed up with goals, strategies, and tracking of outcomes, he says.

Hospitals have the same financial incentive as other employers: Employee health and wellness programs provide a healthy return on investment. A majority of hospitals that tracked their ROI reported a return of investment of $2 or more for every $1 they spent on wellness. In fact, the AHA is promoting the sharing of "best practices" from hospitals that have developed their wellness programs.

Healthcare reform provides a new basis for promoting wellness. The Affordable Care Act provides incentives for preventive health programs and creates a fund to invest in prevention and public health. It requires insurers to cover some preventive services, screenings, and immunizations with no co-pay.

Importantly, the Affordable Care Act also creates "Accountable Care Organizations" for Medicare to encourage doctors and hospitals to coordinate care and emphasize prevention. "Your own employees' health is an accountable care organization," says Joshi, who notes that hospitals can focus on their own employee base to improve prevention and management of chronic diseases.

Health risk assessments and biometric screening can identify the employees who have risk factors for chronic diseases. But how can you convince them to take significant steps to improve their health?

The AHA advocates the use of employee incentives to promote participation in wellness programs. About two-thirds of hospitals already report using some incentives, according to the survey. Most of the incentives are based on participation, such as completing a health risk assessment or biometric screening, or participating in disease management or weight loss programs.

One-third of hospitals surveyed offer $100 to $300 in annual deductions from health insurance premiums. Other incentives include lower deductibles, contributions to health savings accounts, subsidized gym membership, gift cards, or small tokens such as T-shirts and mugs.

Incentives vary based on an organization's culture, says Joshi. But it's important to identify goals and measure your progress, he says. "There should be clear measurable goals for the longer term as well as the short term," he says.

Focus on sustainability

The AHA report provides seven recommendations, with some specific suggestions on goals and strategies:

• Recommendation 1: Serve as a Role Model of Health for the Community

As part of fulfilling their mission, hospitals are beacons of trust in the community. Hospitals must create robust health and wellness programs as examples to the communities that they serve.

• Recommendation 2: Create a Culture of Healthy Living

Improving the health of employees is more than implementing individual health and wellness programs or activities. Hospitals need to strive for a culture of healthy living for all employees, which starts at the top with the CEO and the board of trustees. Wellness should be a strategic priority for the hospital.

• Recommendation 3: Provide a Variety of Program Offerings

While health and wellness is more than a set of activities, it is important for hospitals to offer a variety of activities to promote health within their organizations.

• Recommendation 4: Provide Positive and Negative Incentives

Positive and negative incentives are effective in improving health and wellness program participation levels. Hospitals can use incentives to increase participation and to improve outcomes.

• Recommendation 5: Track Participation and Outcomes

To track the success of their health and wellness programs, hospitals must first measure and increase participation and then build systems to track outcomes.

• Recommendation 6: Measure for Return on Investment

A strong financial case accompanies the strategic mission of striving for robust health and wellness programs. To achieve ROI, hospitals must first commit to effectively measuring ROI over several years.

• Recommendation 7: Focus on Sustainability

For program effectiveness, hospitals must motivate employees over time, effectively communicate, and constantly reinforce wellness as a leadership priority.


1. American Hospital Association. 2010 Long-Range Policy Committee, John W. Bluford III, chair. A Call to Action: Creating a Culture of Health. American Hospital Association, Chicago, January 2011. Available at: http://bit.ly/dOhrla