Ever find yourself wondering what results people actually expect from an employee wellness program? 

Over the years I have had lots of conversations trying to nail this issue down with executives and program staff. One executive I talked with had a crazy idea that just doing a wellness program in any old way would produce all kinds of impact on his health plan costs.  I tried to reason with him to help him see that the way you do wellness programming will have an enormous impact on the magnitude and type of results you get.  Unfortunately, he proved to be closed-minded about this issue, to his ultimate disadvantage and the ultimate demise of his wellness program.

Having been involved in more than  1,000 employee wellness programs over the past 40 years has left me with the very strong belief that most business leaders know very little about the results of wellness programs.  That’s why I developed the Wellness Program Results Hierarchy diagram in this issue of Connections.

This diagram is intended to provide a number of key insights about wellness program results.  The major insights are:

• Worksite wellness programs have a profound potential to improve the lives of employees and to achieve significant economic benefits for both employees and employers.
• However, there is a “hierarchy” of results that need to be addressed in the design and operation of employee wellness programming.
• Results of these programs are linked in various ways to each other – sometimes in unappreciated or underappreciated ways.
• There are “lower-order” results that are required to produce “high-order” results.
• You generally cannot get the “higher order” results without attaining the “lower order” results first.
• You don’t get the “higher-order” results unless you “cross the chasm” and move from short-term to long-term wellness behavior.
• Using the terminology “crossing the chasm” should become a major part of our discussions with senior managers about employee wellness programming.
• Few wellness programs use specific strategies to “cross the chasm” and achieve long-term wellness behavior change among participants.
• Getting the full results of employee wellness programs takes more effort than most employers want to expend. (Thus, the importance of the economics of worker health.)

Why is this important?

This diagram is critically important because it lays out an easily graspable perspective on the expected results for these types of programs.  The hierarchical structure means that you don’t get the higher order results without attaining the lower order results first.  The hierarchy communicates the “inconvenient truth” that wellness programs are not going to produce their full potential results without a significant commitment from employers to attain the lower level results.  That commitment has to include a sound program design, dedicated and adequate resources, management priority, skilled staff, and a long-term commitment. They say one picture is worth a thousand words and this picture (graphic) is no different. This diagram can also be used to help explain why the current wellness program may be underperforming or not delivering the “desired goods.”

Another reason this graphic is important is that it provides an all-too-rare focus on the importance of moving beyond short-term wellness behavior and actually helping people make long-term wellness behavior change.  You don’t get the higher order programming results without helping employees and their family members make long-term behavior change. If senior managers don’t appreciate the need to “cross the chasm” and move employees into long-term behavior change they will usually be disappointed in their wellness program efforts.  This frequently leads to inadequate funding, lackluster programs, and minimal program effectiveness.

An additional reason that this graphic is important is that the “chasm” can be crossed by emphasizing the AMSO construct.  Remember AMSO from the training?  Each certification level of the WellCert program delves deeper into how to use AMSO to assure the shift from short-term behavior change to long-term thereby “crossing the chasm.” AMSO speaks to having in your program: an annual awareness-raising activity for all participants, strategies that enhance the level of motivation of participants, ways of helping people acquire the new skills associated with the new healthy behavior(s) they want to adopt and the provision of sufficient opportunity for them to practice the new skills.

How can it be used?

Here’s what you could do with this document:

• First, spend some time looking it over to fully absorb the significance of the hierarchy and the implications mentioned above.
• Next, determine when and where you might use the diagram with senior managers, mid-level managers, advisory group members and wellness champions.
• Use the diagram to make a pitch for increased budget or movement to a Result-Driven program model.
• Think about how the graphic might fit into periodic briefings with management.
• Try putting some of the key metrics into the framework to help managers understand the program’s potential impact.
• Use the diagram in your program evaluation efforts to provide an alternative framework to consider.
• Use the diagram to present the AMSO construct as a way of helping assure the program results management wants from the wellness program.

In summary, this 1-page diagram can be used to help your senior management understand what it takes for your wellness program to produce the results that are desired.  Program staff can use the diagram to explain why the program is under-performing and to make a case for increased funding or a shift in program strategy.