The Health & Productivity Institute Of Australia Best-Practice Guidelines
01HAPIAThe Health & Productivity Institute of AustraliaBest-PracticeGuidelinesWorkplace Health in Australia
02IntroductionChief Executive Officers of leading organisations areoften asked what makes their company successful.Increasingly, the answer is ‘our employees are ourgreatest asset’, or in other words, their human capital.1Improving employee health not only has the capacity to controlexpenses, but also protect, support and enhance human capital.2 3This has led an increasing number of Australian organisationsto adopt workplace health programs, with key drivers includingthe management of an ageing workforce, workers compensationcosts, corporate social responsibility and being an ‘employer ofchoice’. These organisations are reaping the benefits of suchprograms including greater job satisfaction, reduced staff-relatedcosts, improved employee engagement, less absenteeism, higherproductivity and ultimately higher profits.4Workplace health has progressed from it’s ‘nice to have’ and‘right thing to do’ image, and has become a key businessperformance driver. The question is no longer whetherprograms should be adopted, but how they should bedesigned, implemented and evaluated to achievemaximal benefits.5As there is no ‘one-size fits all’ approach, the Healthand Productivity Institute of Australia (HAPIA) recognised theneed for a comprehensive set of guiding principles to supportthe development of best-practice workplace health programswithin the Australian setting.About usThe Health and Productivity Institute of Australia is the peakbody of workplace health providers in Australia. HAPIA wasformed in 2007 by Australia’s leading providers who soughtunified representation to government and business inrelation to the role of the workplace in preventative health.Our PurposeHAPIA’s mission is to contribute to the health reform debate,to improve health outcomes and reduce health system coststhrough its focus on prevention, particularly preventativeservices delivered to employees at the worksite.HAPIA also oversees standards and accreditation, funds research,supports evidence-based approaches to corporate health, andpromotes ethical business practices within the industry.This ensures clients receive only accurate, evidence-based,outcome-focused services and wise investments.In 2007, HAPIA launched the inaugural Australian Health andProductivity Management Congress. With both national andinternational speakers, this annual congress targets those who haveadopted, or are planning to adopt, workplace health programs fortheir organisation. The congress highlights the ‘asset value’ of theworkforce, together with the latest trends and research,and best-practice Australian case-studies.Further InformationFor further information regarding HAPIA, including a list ofour members, please visit our website at www.hapia.org.au
03ContentsIntroduction02Introduction04What is Workplace Health?05Workplace Health, a Global Snapshot06What’s the Value Proposition?07What’s the Evidence?Best Practise Guidelines09Active Support and Participation by Senior Leadership10Workplace Health as a Shared Responsibility11Engagement of Key Stakeholders12Supportive Environment by Senior Leadership13Participatory Planning and Design14Participatory Planning and Design (con’t)15Participatory Planning and Design (con’t)16Targeted Workplace Health Interventions17Targeted Workplace Health Interventions (con’t)18Standards and Accreditation19High Levels of Program Engagement20Innovative Marketing and Communication21Evaluation and Monitoring22Commitment to Ethical Business Practices23Is SustainableBest Practise Studies25Forestry Plantations QLD26Boral27Department of Public Works28Greenslopes Private Hospital, QLD29Further Information30References31References32References
04What isWorkplace Health?As workplace health has evolved, many different termshave been used to describe the industry.This includes workplace health management, corporate health,and health and productivity management. HAPIA believes theterm ‘workplace health’ best reflects today’s approach whichacknowledges the multiple determinants of employee health,and is more holistic and integrative in nature, addressing bothindividual and organisational factors.This is reflected in the definition below:Workplace health represents “the combined efforts of employers,employees and society to improve the health and well-beingof people at work. This is achieved through a combination ofimproving the work organisation and the working environment,promoting the active participation of employees in health activitiesand encouraging personal development.”(Adapted from ENWHP, 20078).Why the Workplace?In the changing world of work, motivated, qualified and above all,healthy employees are essential for Australia’s future economicprosperity.9 With Australians spending approximately 1/3 of theirlife at work, the workplace plays an important role in the physical,mental, economic and social wellbeing of workers, and in turn, theirfamilies10. The workplace has subsequently been recognised as apriority setting for health promotion by the World Health Organisationand Australian governments.11 12 13 14 This is also reflected in thegrowing demand for green buildings, the implementation of work/lifebalance policies, technology to support flexible work practices andthe trend to provide amenities such as onsite gymnasiums and childcare facilities.15There are a number of additional reasons why the workplaceis an ideal setting, including (but not limited to): 3 10 16 17 Australian employees average 4 health risk factors per person;18 E ase of access to a large number of people, includinghard-to-reach groups; E xisting infrastructures (e.g. communication channels,supportive environment); O pportunity to tailor interventions to support the needsof specific groups of employees (e.g. shiftworkers); Cost-efficiency relative to clinical or community-based programs; E ffectiveness of interventions which can be readily monitoredover time; O pportunity to address multiple levels of influence onemployee wellbeing; T hrough an integrated approach, opportunity to support andmutually reinforce health and safety, human resources andorganisational development; and Decreased burden on public health system.Hence, a greater focus on workplace health over the comingdecades has the potential to deliver benefits for both the Australianworking population and employers.
05WorkplaceHealtha Global SnapshotMarketplace activity, together with recent research, provides strong evidence that organisations, nationallyand internationally, are increasingly recognising, and valuing, workplace health for the magnitude of benefitsto both their organisation and employees.Global PerspectivesThe prevalence of workplace health programs globally is risingrapidly.19 The international movement is led by associations suchas the Institute for Health and Productivity Management (U.S.)and the European Network for Workplace Health Promotion.6Geographically, workplace health programs are most prevalentin North America, where 82% of employers report having workplacehealth offerings, with the main driver being reducing health carecosts. Outside of the US, the main drivers are reducing absenceand improving employee productivity, workforce morale andengagement.19 In the United Kingdom, the government is aimingfor 75 per cent of FTSE 100 companies to report on theiremployees’ wellbeing at board level by 2011.20Australian PerspectiveThe concept of workplace health has developed and gainedmomentum in Australia since the late 1970’s, undergoing asignificant evolutionary process.10 The growth of the industry isdue largely to the position it occupies at the confluence of political,economic, technological, safety, injury management and publichealth developments.22 This growth is expected to continue withrecent government schemes including WorkHealth (VIC), Councilof Australian Governments National Partnership Agreement onPreventative Health, and launch of the Australian PreventativeHealth Agency in January 2010.14 22 Currently 1500 workplacehealth programs covering 400,000 employees are providingsome sort of workplace health or preventative health program.3Hence, a huge opportunity exists for Australian business toimprove performance through a focus on organisational health.“The Global Financial Crisis has highlighted the criticality of finding sustainablesolutions to increase productivity and reduce costs whilst also increasing creativityand innovation to position companies for the future” , Right Management, 2009Quick Fact: 96% of ‘Best Practice’ Australian organisations implemented healthand wellbeing initiatives during the last 12 months.
06What’s theValue Proposition?Like their international counterparts, Australian business leaders are recognisingthat ‘healthy employees equal healthy organisations’.9For employeesThe benefits of participating in workplace healthprograms include (but not limited to): 3 16 31 32 Improved health awareness and knowledge Increased work enjoyment and fulfillment Improved concentration and productivity Improved team relationships Improved physical and mental wellbeing and resilience Increased energy and vitalityFor employersThe benefits of providing workplace healthprograms include (but not limited to): Improved productivity Increased creativity and innovation Improved employee engagement Improved staff morale Reduced presenteeism (health-related work impairment) Increased attraction and retention of staff Reduced workplace injury and workers compensation costs Improved employee relations Improved corporate image Managing an ageing workforce Reduced sickness-related absenteeismQuick Fact: Organisations that don’t promote health and wellness are four timesmore likely to lose talent in the next 12 months.25
07What’s theEvidence?‘Investment by businesses and private health insurers in health management and wellnessprograms reflects a commercial assessment that such programs generate a positive returnon investment’ National Health and Hospitals Reform Commission, 2008 29Workplace health is not just a ‘nice to have’ for organisations.Strong evidence exists for the effectiveness of such programs,benefiting the wellbeing of employees and the companies whichemploy them. A win-win situation!A recent HAPIA publication identified over 600 national andinternational studies had been published in the past 2 decades,including multiple large meta-evaluations, 26 27 which providedcompelling evidence that workplace health programs providea solid return on investment (ROI).3Comprehensive workplace health interventions, incorporatingindividual approaches and changes to workplace culture andstructure, have been shown to have the most impact.2 28Hence, employees with better health spend more time at work,and are more productive when they are, reinforcing the universalbelief that employees are a company’s greatest asset.Subsequently, the question is whether Australian workplaces canafford NOT to invest in the health and wellbeing of their workforce.In a recent large meta-evaluation, workplace health programsresulted in an average 25.3% decrease in sick leave absenteeism,40.7% decrease in workers compensation costs, 24.2% decrease indisability management costs and 5.81 saving for every 1 investedin employee wellbeing.27Quick Fact: Research indicates that in organisations where workplace health ismanaged well, financial performance increased by more than 2.5 times. 25
08Best-PracticeGuidelinesAs no two organisations are the same, it isdifficult to have a fixed formula for a successfulworkplace health program. However, thereare key characteristics that successful andsustainable programs share. Consistent withcurrent research and best-practice, there are12 guiding principles for development andimplementation of a results-oriented program.
09Active Supportand Participationby Senior Leadership“When CEOs value healthy lifestyles and openly practice good health habits,the rest of the organisation is likely to follow in their footsteps. To be genuinein promoting health, CEOs need to embrace health as an individual priority.This does not mean they have to be a marathoner or ‘health nazi’, it just meansthat they value health and wellbeing and take steps to protect it’ ’, WELCOA 2006Senior leadership support is critical to building and sustainingsuccessful workplace health programs.30 This goes beyondsimple endorsement of programs and involves active and visibleparticipation.31 32 Indeed, it has been HAPIA’s experience that whenthe CEO gets behind workplace health initiatives that things reallystart to happen!There are eight primary roles that the senior leadership team,particularly the CEO, must embrace: 33 341. Creating the vision (e.g. mission statement)2. Connecting the vision to organisational values, strategy,practice and policy (i.e. build a health culture)3. Gaining budget and resource commitment4. Educating and engaging senior managementQuick Fact: Management-related factors havebeen shown to contribute more to success thanthe content of the (workplace health) intervention.5. Sharing the vision with employees6. Serving as a role model (i.e. walk the talk!)7. Accountability and responsibility(e.g. KPI’s for senior management)8. Rewarding success (e.g. incentives, public recognition)Barriers to leadership support will exist such as limited resources orcompeting business priorities but can be overcome in a number ofways. For instance, undertaking a pilot workplace health programwith senior management before rolling out a broader program cangenerate enthusiasm and support and create a cascade effectthroughout the organisation.30
010WorkplaceHealthas a Shared ResponsibilityThe effective delivery of workplace health programsrequires a mutually beneficial partnership betweenemployers and employees, which encourages both partiesto take and accept responsibility for health in the workplace.36Similarly, experience suggests that part financial contributionby employees for select initiatives (e.g. gym membership, smokingcessation), fosters responsibility for, and ownership of, individualwellbeing, and leads to a higher rate of adherence.‘Workplace health is something we do with and forpeople it’s not something we do to them”,David Hunnicutt, WELCOA President, 2009
011Engagementof Key StakeholdersA healthy workplace is only attainable through the commitment and cooperation of employers,employees and employee representatives working collaboratively.37This can be achieved through a number of strategies including:Establishing a WorkplaceHealth CommitteeThis committee is responsible for planning, overseeing and executingthe workplace health program. This will serve to optimise employeeengagement and foster a sense of program ownership.The committee structure, composition and meeting frequency willdepend on the size of the organisation and scope of the program.It should include representatives from all levels and sectors of theworkforce (including human resources and/or health and safety),who are enthusiastic, motivated, and with strong leadershipskills and a health interest. It is suggested that new membersbe appointed every 1-2 years, and be provided with the requiredprofessional development (e.g. training in health promotionprinciples), allocation of work time and resources to conducttheir role effectively.10Appointing a WorkplaceHealth CoordinatorA Workplace Health Coordinator should be appointed bySenior Leadership or elected by the Workplace Health Committee.Their primary role is to lead the Workplace Health Committee andto coordinate the internal delivery of the program. Ideally this personwould have a health background, with skills and expertise inmanagement, planning, coordination and strong communicationskills across a diverse range of audiences.38Identifying and EstablishingWorkplace Health PartnershipsTo support the delivery of a comprehensive workplace healthprogram, organisations may seek strategic partnershipsand/or support from local providers, onsite third party/s,not-for-profit organisations (e.g. Heart Foundation) orworkplace health providers to provide necessary expertise,experience and resources. A list of HAPIA accreditedproviders is available on our website www.hapia.org.au
012SupportiveEnvironmentby Senior LeadershipHow do you integrate workplace health into the “DNA” of anorganisation? Through developing a supportive environmentand culture, or in other words, ‘making healthy choices the easychoices’. As employees spend more waking hours at work thananywhere else, it is unsurprising that this fosters higher programparticipation, adoption and maintenance of healthy behaviours,together with a reduction in major health risks and increasedproductivity.15 35 39The ideal workplace environment has been described as agreen, campus style, family friendly and smart workplace.15 Theenvironment can be assessed utilising tools such as the ‘Checklistof Health Promoting Environments at Worksites’ (CHEW) whichidentifies environmental characteristics that influence healthrelated behaviors.40 For example, if a company provides a weightmanagement program, but only provides high-fat, non-nutritiousfoods in the vending machines and at meetings, it is unlikelyindividuals will be able to achieve and maintain long termbehaviour change.Examples of other strategies include:39 42 P hysical environment – onsite fitness and child carefacilities, showers and lockers, secure bike storageand smoke-free buildings; P olicy environment – flexible working arrangements,workload management, smoke-free, healthy catering.Workplace culture can also be assessed via an audit toidentify the cultural supports for employee health, and areasfor improvement, across the following dimensions:33 Norms (‘how things get done around here’) Values (beliefs about what is important) Peer support (assisting colleagues to achieve health goals) O rganisational support (policies, procedures, rewards,communication); and Climate (sense of community, shared vision)‘Members of a healthy culture are able to systematically align values, norms,peer support, organisational climate with individual and organisational challengesand opportunities. The primary ingredients of a health culture are leadership,knowledge of cultural change, kindness and engagement of the entire population’Judd Allen, 2000
013ParticipatoryPlanningand DesignEstablishing NeedsThe first step in creating a successful workplace health program isto understand employee and organisational needs. A ‘participatory’needs assessment will determine the scope, content and approachof health initiatives, and ensure employers are investing in the ‘right’programs. It will also provide the baseline from which the impactof the future program can be gauged. Groups will invariably differdepending on the nature of the organisation and the type of workperformed (e.g. blue collar versus white collar). Social and culturaldifferences will also play a role. As risks are not static, the needsassessment should then be conducted on an ongoing basis as partof the program management and evaluation process.You can’t manage what you can’t measure’,Peter Drucker, Writer/Management Consultant(1909-2005)The objectives of the needs assessment are to: Establish a baseline individual and organisational health profile; D etermine the direct (e.g. workers compensation costs) andindirect (e.g. absenteeism, productivity) health-related costs tothe organisation; Identify ‘hotspots’ across the organisation; D etermine workplace capacity and/or constraints (e.g.budgetary, communication channels, environment, culture); P rovide a ‘gap analysis’ of current onsite and communityresources, services and facilities; E nsure future health initiatives best meet the needs ofemployees based on readiness-to-change, health behaviour,risk status, and interest, maximising participation and ROI;A comprehensive needs assessment involves 5 steps:321. Consultation (e.g. key stakeholders, focus groups)2. Data collection (e.g. organisational demographics and metrics,employee health risk appraisal, workplace environment/culture,past surveys)3. Analysis of data (e.g. trend analysis, benchmarking)4. Determine priorities (e.g. magnitude, potential impact, feasibility,resources, goals/objectives)5. Inform stakeholders of the findings and recommendations(i.e. senior leadership/management, Workplace HealthCommittee and employees)
014ParticipatoryPlanningand Design continued.Developing the ProgramAs indicated previously, an effective workplace health programsimultaneously addresses the individual, environmental, policyand cultural factors affecting employee wellbeing (see Figure 1).28 43In developing a comprehensive program, it is important to: 16 (note– specialist expertise may be required to support this process) Use the needs assessment data to target interventions; Learn from others success (e.g. award-winning or best-practicecase studies); Determine goals and objectives in line with S.M.A.R.T. principles; Determine what interventions will be offered and the level ofintensity (see SIMPLE criteria below); Consider key enablers (e.g. strong leadership) and challenges(e.g. potential timing, employee scepticism) for implementation Engage the necessary providers, resources and commitment; Devise an operating plan including timelines, roles andresponsibilities, budget and marketing, communication,monitoring and evaluation strategy; Test the proposed framework with key stakeholders(e.g. senior leadership, Workplace health Committee)to ensure program buy-in; Have a long term vision (3-5 years).The following criteria can be used for choosing suitableinterventions for workplace health programs:32Specific to needs (e.g. based on goals/objectives, target audience, multi-level)Innovative (e.g. latest approaches, simple yet flexible)Manageable (e.g. sufficient resources, cost-effectiveness)People-oriented (e.g. accessibility, targeted)L asting (e.g. sustainable, follow up, integration with corporate strategy)E vidence-based (e.g. based on reputable studies/interventions)Cost GuidelinesFinancial investment in the workplace health program may varyand fluctuate widely, depending on whether the employer paysall costs, the employee pays all costs, or the costs are shared.39HAPIA estimates the annual cost per employee to be 100- 300 foran effective workplace health program, with targeted cost-effectiveinterventions. Whilst small to medium organisations may questionthe feasibility of such programs, the proposed framework is ofteneasier to implement in smaller organisations, as the culture is moreamenable to change, and communication channels more effective inpromoting the benefits between management and employees.31“The business case for health management indicatesthat the critical strategy is to ‘keep the healthy peoplehealthy’ (‘keep the low-risk people low-risk)” DeeEdington, 2009
015ParticipatoryPlanningand Design continued.Figure 1. Sample multi-faceted and multi-levelstrategies to increase physical activity15 32CulturalPolicy Discouragement of sedentary behaviour(e.g. Host ‘walk and talk’ meetings) Flexible working hours to allow for physical activity(e.g. lunchtime walk) Physical activity breaks during the working day (e.g stretching) Subsidised gym memberships, corporate sporting eventsor onsite fitness opportunities (e.g. yoga) Health-related social functions (e.g. lawn bowls, touch footy) Active leadership and participation by senior management Subsidised equipment purchase (e.g. bike scheme) Promotion of physical activity in everyday work dutiesIndividualEnvironmental Provision of active transport facilities in safe, convenient andaccessible locations (e.g. bike racks, changerooms, showers) Provision of onsite fitness facilities / services Pedometer challenges Educational and awareness strategies(e.g. lunch’n learn sessions, newsletter articles,online tools, expos, Walk to Work Day) Health risk assessments Proximity to bicycle paths, walkways, parklands and publictransport Provision of adjustable workstations Encouraging use of internal stairwells through motivationalsignage and making them more accessibleGroup Seminars Health Fairs Provision of maps of suitable lunchtime walking routes topromote walking/joggingImplementing the ProgramThis step is all about ‘making it happen’. This requires strong leadership and an innovative engagement,communication and marketing strategy. This is discussed in Guidelines 6 and 8.
016TargetedWorkplaceHealth InterventionsA multi-faceted workplace health program can be broken down into three types of interventions 42Core Components which are available to all employees(e.g. health risk assessment, flu vaccination, employee assistanceprogram). The decision as to what is “core” is driven by theunderlying philosophy of the program, it’s objectives, andbudgetary constraints;Discretionary Components which require participants to meetcertain eligibility requirements (e.g. high risk employees or thosein physically demanding jobs); and Local Components whichcater for the special needs and/or interests of target groups,usually in relation to their site or job function (e.g. team challenges,managing a shiftwork lifestyle).“A personal health screening opportunity is such an important component(of a workplace health program) that it is virtually impossible to establishany type of effective workplace health program without it”. WELCOA (2006)A variety of delivery mechanisms ensure interventions reachtheir intended target including: Online Telephonic Face-to-face individual (e.g. assessments, coaching) Face-to-face group (e.g. workshops) Self Managed Programs Miscellaneous e.g. expos, team-based
017TargetedWorkplaceHealth Interventions continued.A list of common workplace healthinterventions are listed below:Health Risk Assessments (HRA)Conducted online, face-to-face or a combination of the two, thesevary in length and complexity, but tend to focus on lifestyle related(preventable) issues.Health AssessmentsConducted face-to-face, usually onsite and have the advantageof including direct measurement of biometric data which is notmeasured in the HRA. Biometric measurements often include BMI,Waist measurement, BP, Cholesterol (with or without HDL/LDL),Blood glucose etc.Executive Health Assessments (EHA)Comprehensive assessment which usually includes evaluationof physical, medical, psychological and lifestyle related risks.Generally conducted in a dedicated facility by a medical doctorand other allied health professionals. The EHA will usually includeextensive pathology (via venupuncture), stress ECG, Spirometry,BP, Skin Check, PAP smears etc and more comprehensive servicesmay cover Bone densitometry and mammography.Health CoachingNormally linked to a HRA, Health Assessment or EHA, thispersonalised form of coaching can be delivered face-to-face, ortelephonically, and is well-suited to high risk individuals, with astrong focus on lifestyle-related behaviour change.Self Managed Behaviour Change ProgramsAlso normally linked to an HRA and delivered online, these modularprograms share many features with Health Coaching programs,focusing on lifestyle-related behaviour change and often supportedby the provision of applications such as activity and meal plannersto allow individuals to personalise their programs.Health PromotionInterventions include a variety of awareness and educationactivities across a range of health dimensions (e.g. healthy eating,sleep management), and can be delivered in a variety of formats(e.g. expos, online).Vaccination programsNormally conducted onsite, and include seasonal influenzavaccinations and other vaccinations which meet occupationalhealth requirements (e.g. for health professionals), together withtravel vaccinations and advice for employees required to traveloverseas.Pre Employment MedicalsThese are carried out to evaluate an employee’s functionalcapacity to perform the tasks inherent in a job and susceptibility toparticular substances, injuries or diseases.Seminars & WorkshopsGroup educational sessions which may cove the entire spectrumof health related risks and behaviours.Facility Design and ManagementProfessional guidance and/or support regarding the design,establishment and management of onsite gymnasium or healthfacilities (e.g. layout and design, staffing, OHS requirements).Health ActivitiesCan include group exercise classes, yoga, Tai Chi, Boxercise etc.Work Life BalanceThis includes initiatives to support work life needs includingfinancial health, time management and positive parenting.Other interventionsOther options include such things as massage, skin checks, healthfairs/expo’s, smoking cessation programs, weight managementprograms, resilience workshops, cooking demonstrations etc.
018Standardsand AccreditationThe delivery of results-orientated workplace health programsrequires creative programming led by engaging, well-informedand competent internal or external providers. A broad range ofdisciplines can be involved in the delivery of workplace healthservices including exercise physiology, nutrition, psychology,financial planning and workplace health providers.In choosing a workplace health or related provider, whether internalor external, the provider should: 39 42 Have a track record in the provision of services they intendto deploy; Provide testimonials/references in support of this; Be a member of the relevant industry body (e.g. HAPIA,Australian Association of Exercise and Sports Science); Hold the required professional indemnity/liability insurances; Use only degree qualified professionals where appropriate(e.g. delivery of health assessments or coaching); Ensure responsible management, referral and follow up of highrisk particip
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