Good wellness programs are continually improving their offerings. The process of continual improvement requires the use of program outcomes data to help determine program effectiveness. Here are 5 questions you should ask before you evaluate a wellness program.
1. Why Do You Want to Evaluate a Wellness Program?
Historically, company leaders have looked at wellness programs as a company perk rather than a defined employee benefit. As a perk, leaders asked for evaluations that determined wellness program value and whether these programs were worth the cost.
Today, wellness programs are less likely to be considered perks and are more likely to be considered part of a defined benefits package. Still, the employers who conduct wellness program evaluations want answers to questions like:
- How many employees and spouses participate?
- How many are earning incentives?
- Are health behaviors and health risks improving?
- Is company morale improving?
- Is the program saving the worksite more money than it costs?
- Do employees like the program?
- How can we make our wellness program better?
Every wellness program evaluation will find one of three outcomes: things improved, they got worse, or they didn’t change at all. What you need to decide now is what your response will be to each of these potential outcomes.
Whatever your reason for conducting an evaluation, it is helpful to think through each option before you conduct the evaluation.
2. What Should You Evaluate?
You should start by asking why you have a wellness program in the first place. There are several answers to this question. Interestingly, 91% of U.S. employers report offering health and well-being programs for reasons beyond medical cost savings.
While some employers start wellness programs to help control employee-related expenses like healthcare costs or improve productivity, over time, cost savings becomes less of a concern in most cases.
In an earlier post I reviewed the 5 most important reasons to have a wellness program.
After several years of program participation, employers begin to see the value that wellness programs provide. “Value” is above and beyond reduction in employee related expenses. Added value can be determined in a Value On Investment (VOI) evaluation.
VOI is not easy to understand because the term is not very descriptive. Typically, wellness program outcome measures that are part of wellness VOI are self-reported, require additional data collection and expense, and can often be considered “softer” measures.
Some VOI metrics include job satisfaction, performance, and morale. Value can refer to anything that increases workforce productivity, retention, morale, or performance.
Good worksite wellness programs impact employee morale, but how exactly can employee morale be quantified? The same could be asked about measuring team cohesiveness, recruitment, or retention. Value-based outcomes are hard to accurately measure.
A VOI analysis does not look at the same things as a wellness Return on Investment (ROI) evaluation. An ROI report answers the question of whether wellness is worth the investment.
By contrast, a VOI report assumes wellness investment but asks the question, “Where is the best place to start?” In other words, it wants to find out which emphasis will deliver the biggest “bang for the buck.”
The table below shows a list of common reasons for doing worksite wellness. They are divided into outcomes that are related to a wellness program’s ROI and VOI. The table also shows the type of data that can be used in the evaluation.
Most wellness programs use an online platform to help administer and deliver their program. These platforms can instantly create evaluations of a variety of program outcomes. The table also shows which outcomes can be automatically evaluated with a digital wellness platform.
Some employers want to know how many employees are clicking on different pages.
Tracking clicks is popular with today’s technology; however, wellness program effectiveness is better measured by participation, improvements in health behavior, reductions in health risks, or a positive return on investment.
Clicks are nice and they show effective communications, but clicks don’t necessarily result in improved health.
The outcomes to evaluate often vary by company size. Small companies with fewer than 100 employees will have a more difficult time conducting an ROI analysis because they don’t have enough employees to provide adequate data. Larger companies do have adequate data.
They also have the resources to evaluate pretty much any aspect of the program. These evaluations are time consuming and demand significant expertise, often requiring outside consultants.
The table below shows various wellness outcomes to evaluate by the size of the company. In general, the smaller the organization the more difficult it is to do some evaluations.
3. How Do You Evaluate a Wellness Program?
Your evaluation approach depends on the outcomes that you want to study. On the one hand, you can look at data at a single point in time and get a snapshot of that particular outcome at that particular moment.
For example, calculating the number of program participants is a great way to determine how much engagement your program is getting. At any point in time, a percentage of employees will be participating.
On the other hand, measuring changes across time provides more robust information. These types of evaluations have different names like pre-test/post-test, baseline/follow-up, or repeated measures. The idea is to evaluate if an outcome changes across time.
For example, if the number of employees with high blood pressure decreases during the same time your wellness program offers a hypertension control program, the improvement may be due to your wellness efforts.
The highest standard is generally considered to be a randomized clinical trial; however, randomizing some employees to receive the hypertension program while others are randomized to a control condition is simply not ethical.
So, while the pre-test/post-test evaluation might suggest that the program was effective, the improvements could be due to other things.
Perhaps the hardest part of actually doing the evaluation is getting accurate data. Getting data becomes much easier if your wellness program uses a web-based wellness platform.
Think of wellness platforms as data warehouses where all participant data is contained. These platforms can be used to administer wellness programs, schedule challenges, gather biometric data, administer incentives, and create reports.
Used correctly, these platforms can provide enormous amounts of program evaluation data. If your program uses a wellness platform, you should be able to evaluate many of your program outcomes.
Below is a list of wellness program outcomes and possible sources where you might be able to locate data on those outcomes.
4. How Should You Interpret Your Findings?
Interpreting your findings is really all about determining what works, what doesn’t, and how confident you are. This is where some of the more common problems can arise.
A common evaluation tactic is to look at the data from program participants at baseline and again at some later time. Most wellness program coordinators will simply look at the aggregate reports at baseline and compare the results from the follow-up.
The problem with this approach is the people who participated at baseline are not entirely the same people who participate at follow-up. Employees retire, get fired, and get transferred, all the while new employees start working. In some worksites, employee turnover can exceed 50% per year.
The results you may have from this type of evaluation are unlikely to demonstrate the true impact of your wellness program because your data come from different employees.
A better way is to only evaluate individuals who have data from both time periods. You’ll have a smaller number of people in your evaluation but your results will be much more accurate.
The level of confidence in your findings really depends on how accurately you do your evaluation. If your evaluation uses questionable data, your results will be just as dubious.
The American writer Mark Twain understood the dubious nature of some evaluations when he said, “There are three kinds of lies: lies, damned lies, and statistics.”
5. What Should You Do with the Results of Your Wellness Program Evaluation?
Every worksite should be working to enhance their wellness offerings. You can get rid of aspects of your program that don’t appear to be working or modify them to make them better.
The results from your evaluation can also be used to justify the existence of your program. Company leadership will probably appreciate any data like this.
Care should be taken interpreting your results. For example, employee obesity follows the same trends as public obesity. Over time, most populations are gaining weight.
As a result, wellness programs will have a difficult time helping employees achieve and maintain a healthy body weight. Thus, most wellness program evaluations will show that body mass index does not improve over time.
However, just because employees don’t lose weight over time does not mean that your program was a failure. It is a huge success when employees are not heavier at follow-up.
Since the public health trend is to gain weight, any wellness program that is able to help people keep their weight stable should be considered progress.
One of the most impactful aspects of your data is personal testimonials and comments. Human beings are emotional creatures. It’s great to have lots of empirical data, but nothing can replace the impact that comes from having individual employees comment on their wellness successes.
Don’t forget to get comments or stories from your wellness champions. Their experiences and improvements in health may provide some of the best outcomes your program can produce.
Good wellness programs utilize wellness program evaluation to constantly make improvements. Evaluations can take different forms and look at many different outcomes. Try to evaluate outcomes that were identified when you started your wellness effort and use the results to document your progress.