The CDC’s Worksite Health ScoreCard effectively measures workplace wellness efforts and can highlight areas of needed improvement, researchers at Johns Hopkins Medicine (JHM) reported.

Using the CDC scorecard, 11 of the 12 JHM branches improved their overall score from year one to year two.

“The JHM enterprise surpassed national benchmarks in year two,” the researchers reported.1 “Organizations can use the scorecard as an effective measurement tool and as a method to improve the number of evidence-based health promotion strategies provided to their employees.”

Healthy healthcare workers are more productive, contribute to greater patient satisfaction, and are less likely to make medical errors, the researchers emphasized.

“Despite this knowledge, only 46% of U.S. hospital workers agree that their organization promotes a healthy work environment, compared with 69% of U.S. workers overall,” they reported. “In addition, about one-third (35%) of U.S. hospital workers report that current wellness programs encourage a healthier lifestyle, compared with nearly half (48%) of all U.S. workers.”

The CDC scorecard was implemented to address these concerns. It provided an evidence-based employee health strategy that did not undermine the autonomy of local culture, but still drove Hopkins overall in a unified organizational direction. There were several benefits, but the area of nutrition emerged as a challenge.

“The nutrition section of the scorecard was the lowest-scoring topic area across JHM in both years one and two,” the authors reported. “Implementing strategies that are proven to help employees make a healthy food choice may be onerous and cost prohibitive for many employers due to the multiple food access points often available, including vending machines, cafeterias, and retail outlets.” (The scorecard is available online at: https://bit.ly/2qguv6U.)

To delve more into the findings, Hospital Employee Health interviewed one of the study authors, Wendy Bowen, MPH, health promotion specialist in the JHM department of employee health and wellness.

HEH: Can you comment more on the point that the CDC scorecard allowed individual JHM facilities autonomy while providing an overall measurable goal? Is it expected and encouraged that wellness and health cultures will vary somewhat by unit?

Bowen: Autonomy was provided through variation in how entities fulfilled elements contained in the CDC scorecard. Each entity had the leeway to determine which interventions were most appropriate for their local culture and how best to implement their selected strategies. Excluding the “organizational supports” section of the CDC scorecard in which leaders expected a year-over-year point improvement, each JHM entity managed their own strategic direction of topic area improvements. For instance, some entities chose to focus their improvement effort on high blood pressure, whereas others chose to focus on diabetes.

With regard to implementation methods, some entities determined it was best suited to offer in-person educational seminars, whereas others concluded live webinars would be most successful due to a large percentage of its employee population being offsite. Providing entities with implementation flexibility was fundamental in allowing their workplace wellness culture to flourish. There are many different cultures within a large organization, and giving JHM entities flexibility in their CDC scorecard priorities and implementation strategy respects their culture.

HEH: Can you elaborate on why was it important to integrate the effort into the JHM business objectives? It is well known that prevention helps the bottom line, but historically this has been a difficult argument to secure resources.

Bowen: Integrating the CDC scorecard project into the JHM business objectives was one of the most important factors leading to score improvement. It provided accountability for our leadership teams. The year-end results of our business objectives are broadly shared, and this transparency fosters motivation for progress. Our philosophical approach of creating a healthy culture in our workplace is well supported by the socioecologic model of behavior that is the core of the CDC scorecard. Without a certain level of health culture in the workplace, it’s difficult to expect employees to make healthy choices that would help the bottom line over time. When hospitals can utilize a measurement tool that is validated and based on scientific evidence, making the case to integrate it into an organization’s business objectives becomes less difficult.

HEH: Do you think, with measures like the CDC scorecard and ongoing research, that the business case for employee health and wellness is getting easier to make?

Bowen: Historically, employee health and productivity management programs have focused on ROI [return on investment] as a means of proving success. There are many challenges with trying to build a plausible model to attribute programs to cost savings. As a research institution ourselves, we embrace the notion of applying an evidenced-based tool for health promotion programming. I can’t say it is getting easier across the board to make the business case for employee health and wellness. Some employers are stuck in the mindset that a successful program is measured by program sign-ups. We believe in a program whereby employees do not need to sign up to be engaged in their health. When you put an employee in an environment where the easiest choice is the healthiest choice, that’s an easy case to make.

HEH: Do you plan to continue your program, and if so, are there any changes you are planning to make?

Bowen: We plan to continue using the CDC scorecard as a way to quantitatively measure our workplace health promotion efforts and ensure we are improving the number of evidence-based strategies from one year to the next. We also enhance the quality of our strategies each year as we learn from the previous years’ effort. Finally, the CDC will be releasing a new version of their scorecard, so we’ll be adjusting our efforts accordingly.

HEH: Would you recommend this approach to other large hospital systems?

Bowen: I would. Healthcare workers provide services to an ailing population. Ensuring the health of these workers in order to deliver optimal care is imperative. Hospitals have an opportunity to create a healthy workplace for their workers by providing environmental support that encourages healthy choices. The approach we utilized provides large hospital systems with a method of measuring and monitoring interventions over time while also giving multiple entities the ability to create a culture centered around their individual employees.

HEH: What about using the CDC scorecard in small community hospitals?

Bowen: Yes, I would also recommend this approach in small community hospitals. Large systems are not unique in that they face the same challenges as small hospitals in providing evidence-based opportunities for their employees to make healthy choices throughout the workday. Perhaps a small hospital system does not need the same level of implementation autonomy due to a lack of geographic dispersion. However, the CDC scorecard tool is valuable in providing a baseline measure of workplace wellness programs, identifying gaps, and creating a plan of improvement, independent of hospital size.

REFERENCE

1. Safeer R, Bowen W, Maung Z, et al. Using the CDC Worksite Health ScoreCard to Assess Employer Health Promotion Efforts: A Case Study at Johns Hopkins Medicine. J Occup Environ Med 2018;60:e98-e105.