Hospital looks inward for wellness study

Results will be used internally, externally

"Physician, heal thyself," is a phrase with which we are all familiar. Unfortunately, when it comes to wellness programming, all too many health care facilities have ignored this timeless wisdom, devoting their initial wellness efforts to the outside community.

However, Chicago’s Northwestern Memorial Hospital has taken the opposite tack — by design. Its Wellness Initiative for Northwestern Memorial Employees is designed to evaluate the educational interventions that work best in a hospital employee population. Only then, says Northwestern assistant professor of clinical medicine Cheryl Lynn Walker, MD, MBA, can they apply what was learned to the general population. Walker will oversee evaluation of the program.

Cardiologist Neil J. Stone, MD, medical director for the initiative, adds, "When I was asked, because of my expertise in the cholesterol and cardiology areas, to get involved in expanding the wellness program here, I tried to take a look at what it would take in order for us to have a program that would be considered truly a leader in the community. In talking with my colleagues at the hospital and with Dr. Walker — especially about cost-effectiveness — it became clear that if we were to have a wellness program with real impact, we first needed to have buy-in from our employees. To talk about wellness for others when there wasn’t major buy-in at the hospital did not make any sense. We needed to first find the answers in our own business — Northwestern Memorial — and then translate it into communitywide programs."

Walker arrived at the same conclusion through a different route, she recalls. "This wellness initiative is something I worked on at the beginning of the year [1997]," says Walker, whose major area of interest is health economics. "Our initial intent was [simply] to evaluate a corporation. As I began to think which corporation we should try to evaluate, and after speaking with people from the hospital, the thought occurred to me: Why not look at ourselves? We’re all about health and making people better."

The initial health screenings, notes Stone, reinforced the rationale for the wellness initiative. "Just like the general population, a significant number of employees are overweight and under-exercised," he says. "A total of 48% had higher coronary risk than they should; 29% had elevated blood pressure (over 140/90); and 27% had cholesterol over 200.

Specific goals, structure

Walker and Stone have different, though consonant, goals for the program. Walker’s is "To evaluate the economic impact of wellness intervention on the Northwestern employee population, looking specifically at health care services utilization, number of sick days, and self-assessed productivity." Participating employees complete questionnaires regarding these issues; their responses one year later will be compared to those given at the beginning of the program. Assessment will then be made on a department by department basis. What does Walker hope to see? "As participants move along the wellness continuum, utilization will decrease, the number of sick days will decrease, and productivity will increase. This benefits the corporation economically and the employees both economically and in terms of their health."

"My personal motto is, wellness is so important that it should leave a lot to be desired," says Stone. "By that I mean, if we can stimulate people to improve themselves, they will do far more than they ever dreamed."

The components of the initiative, he explains, involve a complete screening including lipid profile, blood sugar, body fat, and a questionnaire to rate risks for a wide variety of illnesses.

Once 15% of the employees with at least one year’s experience with the hospital signed up for the program, enrollment was closed at 485. Stone divided the population into three groups according to their risk levels. These include:

1. Intervention Group: These individuals would not only receive assistance in discussing and establishing new health goals, but they were invited back for interactive education sessions on a monthly basis.

2. Behavior Group: These employees were encouraged to set goals and to change their lifestyles. Follow-up was to be conducted six months later.

3. Awareness Group (in essence, the "control" group): These employees were basically told, "See you in one year."

A local wellness company, Fitness Formula Ltd., is administrating the program, notes Walker. "They will help us implement interventions, all of which will be tailored to the individual," she says.

Employee awareness boosted

The initiative has boosted awareness among non-participants as well, Stone notes. "The hospital already had some existing wellness programs, including blood pressure and cancer screenings, body fat analysis, and self-care analysis," he says. "The wellness manager has noted that since we started the initiative, enrollment is up for the other programs as well." This is critical, he asserts, because "We need true buy-in by the entire population, or it will be very hard to get people to change."

In its second year, says Walker, the program will likely be expanded to allow all employees to participate. "There will also be changes based on our intervention results," she says.

[Editor’s note: For more information, contact, Neil J. Stone, MD, or Cheryl Walker, MD, Northwestern Memorial Hospital, 240 East Ontario St., Chicago, IL 60611-2755. Telephone: (Stone) (312) 944-6677, (Walker) (312) 443-1220.]