What if occ health program isn't getting good ROI?

Low participation and poor survey responses. These are two indicators that an occupational health program may require re-design.

Patti Clavier, BSN, RN, COHN-S, senior project manager of Intel Corp.'s Global Health for Life Wellness Program, has worked with a team of occupational health nurses for the past 10 years on wellness program initiatives. "We typically look at health risk assessment [HRA] results to target such initiatives," she says. "If a program is not having solid participation, we have typically met as a team and looked at new ways to communicate the program, incentivize a program, or re-design the program."

In 2002, the company offered its first HRA as an online program, which was used by about 10% of the population. "The next two years we improved communications, offered a drawing for prizes, and saw continued increase in participation," says Clavier.

During the first four years, employees who took the HRA were entered into a prize draw, with bikes, iPods and other fitness-centric distributed. Participation was 10-20% during these years.

In 2006, increased management support and incentives resulted in even higher participation. "The participation rate is now at the 30-40% level," says Clavier. To further increase participation, an additional incentive is now being offered, based on reward points earned through taking the HRA and through achieving other healthy behaviors.

If a program is just not a success, however, Clavier recommends working with the right people to re-design it. These staff might include management, benefits, communications, and finance. "An integrated team approach to wellness program design, implementation, and program maintenance is essential to success," she says.

What to investigate first

When faced with an unsuccessful program, the first place you should investigate is your needs assessment and planning process, according to Karen Mastroianni, RN, MPH, COHN-S, FAAOHN, co-owner and health and safety strategist for Raleigh, NC-based Dimensions in Occupational Health & Safety, which provides integrated health, safety and wellness solutions for businesses .

Answer this question, says Mastroianni: If all stakeholders were involved and the program was well-planned and implemented, was the return on investment (ROI) realistic and within a realistic time frame?

Evaluating a program's success is complex and is impacted by multiple factors, says Mastroianni. "All of the evaluation markers taken along the way should indicate a pattern or paint a picture. I can't stress enough that evaluation should be continuous, or at least planned at regular intervals, so that there are no surprises at the end," she says. "There should never be surprises at the end."

Mastroianni recommends you do the following:

• Build flexibility into programs, so needed adjustments can be made. For example, programs should be evaluated on an ongoing basis by managers and employees, with the information should be used to revise the actual design when necessary, and sometimes even the expected outcomes.

"If the program is not working and if it's not meeting participants' needs then a change is not only essential, but healthy," says Mastroianni.

• Involve management and employees in evaluation processes to ensure open communication and input.

• Ensure that evaluation criteria are based on established objectives derived from the needs analysis and the data gathered during the planning phase.

• Include the "organizational climate" in the program objectives and the evaluation process.

"Many programs only focus on individual biological health, but health is much more than this," says Mastroianni. "Social and organizational factors can be critical barriers or motivators in decisions to participate in wellness programs." These include coworker participation and health habits, management style, employees input in decisions, and availability of candy or other unhealthy foods.

• Determine whether the program was successful by all indications, including testimonials, but appears unsuccessful due to extenuating circumstances, such as an employee diagnosed with cancer or heart disease. It might be worthwhile to exclude extenuating circumstances and compute the ROI, says Mastroianni.

If all evaluation indicators are positive, yet there isn't an ROI at the end, consider the fact that employees may have sought preventative care and health screenings as a result of information learned in the wellness initiative. "Often, there may be short-term increases before long-term savings are noted," says Mastroianni.


For more information on evaluating a program's return on investment, contact:

• Patti Clavier, BSN, RN, COHN-S, Manager, Global Health for Life Wellness Program, Intel, Colorado Springs, CO. Phone: (719) 273-1027. E-mail: patti.clavier@intel.com.

• Karen Mastroianni, RN, MPH, COHN - S, FAAOHN, Co-Owner and Health & Safety Strategist, Dimensions in Occupational Health & Safety, Raleigh, NC. Phone: (919) 676-2877 Ext. 12. E-mail: karenm@dimensions-ohs.com.