Eat, drink and be healthy (if not wealthy) at work

Health affects your work — and vice versa

Dartmouth-Hitchcock Medical Center in Lebanon, NH, wants its employees to live well and work well. What does that mean? The answer is visible throughout the hospital.

The cafeteria doesn’t sell any fried foods. That equates to 21,250,000 fewer fat calories in a year. It doesn’t sell any sweetened beverages, either. That eliminated 33,700 sugary drinks, or 4,754,000 calories, in the first quarter of 2012 alone.

Beyond those “wow” metrics, many other changes were designed to boost the health of employees. Preventive care is free under the hospital’s self-insured medical plan. Health coaches help with sleep, exercise, tobacco-cessation and weight management.

In the fall, Dartmouth-Hitchcock is launching a full-service primary care practice specifically for employees. “We’re going to provide the right kind of care with the right kind of staffing and not worry about volume. We’re going to worry about outcomes,” says Robert McLellan, MD, MPH, chief of Occupational and Environmental Medicine for Dartmouth-Hitchcock Medical Center in Lebanon, NH, and medical director of the Live Well/Work Well program.

This isn’t just another wellness program. Dartmouth-Hitchcock is committed to fully integrating health promotion with occupational health and safety, he says.

“The name of the program is meant to telegraph the fact that there’s a relationship between living well and working well,” he says. “Health affects your work and work affects your health. That can be true in negative ways — but it also can be positive. We want a virtuous cycle, not a vicious cycle.”

Blurring of work, lifestyle

There has always been some uncertainty in occupational health about the cause of injuries. A hobby, such as tennis or bowling, could affect a person’s joints or muscles as could repetitive motion or awkward postures at work.

Dartmouth-Hitchcock embraces that overlap. The Safety Committee is now called Partners in Health, Environment, Wellness and Safety. “The conversation is an integrated agenda on work environment, [with] interventions to improve safety and wellness in the workplace,” McLellan says.

Investigations of injuries encompass an integrated assessment from a Safety Wellness Action Team. Workplace accommodations take into account both personal health issues as well as work-related injuries.

The payback is in healthier employees who feel more engaged in their work, he says.

“The evidence became overwhelming that in fact lifestyle issues have a huge impact on health care utilization and measures of productivity, like absenteeism, disability and presenteeism,” McLellan says. “This is not simply trying to prevent a heart attack or cancer. There is a financial benefit for businesses to invest in lifestyle.”

There are, of course, limits to integration. Employee health retains important privacy considerations, he says.

Because of the electronic medical records, “there are some special sensitivities to the issue of confidentiality in the health care workforce,” he says.

“The occupational health clinic is distinct from the primary care clinic,” he says. “The occupational health providers don’t have access to your personal health record without your permission. Your primary care doctor is not going to do your fitness for duty or preplacement exam.”

The new paradigm of integrated health protection and promotion fits with the emphasis on prevention in the Affordable Care Act, McLellan says. He expects employers to increasingly embrace the integration of occupational health and health promotion.

“The only way to go at this is comprehensively,” he says. “You can’t have a brown bag lunch and expect to get there. That doesn’t mean you need to start with a million dollar program. But ... you get synergy by integrating these types of programs.”