why worksite health promotion programs are so important:
best channel for providing health information and programs (US Dep't of Health and Human Services, 2001)
evidence that programs reduce absenteeism/medical claims and improve productivity (Aldana, 1998)
result: more programs, more risk factors being covered
problem:
not enough emphasis on evaluation (process, impact and outcome)
leads to no improvements in programs
"low-hanging fruit" - leads to situation where those who need health promotion are abandoned because it is easier to deal with those who don't need it (i.e. the ones who will participate even when there is no program)
WHAT IS THE ANSWER?
changes like the following:
reengineering ... make the programs what they were originally intended to be
demonstration of the value which a health promotion program can add to a business
partnering with others to improve the sense of ownership (i.e. the more people feeling ownership, the more momentum is added)
using better (more efficient) techniques to reach more people
jump-starting stagnant programs
improving corporate culture in order to make lifestyle improvement easier
morphing into the official business plan of the company ... not an "add-on"
signs that a program is a good candidate for reengineering (one or more would be a trigger):
no recent change in the program calendar (or no calendar at all)
emphasis on awareness programs as opposed to education/intervention programs
too much emphasis on extrinsic incentives
no recent change in communications around the program
no recent change in the program marketing plan
no recent evaluation of the model for the program
no recent evaluation of the goals, mission, etc.
no use of committees or task groups in the program
long time since last satisfaction survey
long time since last focus group discussion
long time since last needs/interest survey
no good program evaluation plan
REENGINEERING - A TRANSFORMATION PROCESS
precursors to reengineering:
total quality management (TQM) - Feigenbaum, 1991
holistic process-oriented strategy which looked at all aspects of workplace activities
difficulty in becoming accepted in N. America because of notion of assembly line broke work down into discrete tasks
Japan's focus on quality (Deming and Juran, 1991)
information focus
initially hardware, later process control through elimination of unnecessary work (Hammer and Champy, 1993)
application of business process reengineering to health promotion:
need to refocus programs on clients
Key Elements of Reengineering
three elements (Carr and Johansson, 1995):
process focus
management of change and risk
documented improvement
Process Focused
systematically examine all of the linked activities which make up one set of processes to be executed in a program (e.g. registration):
number of ways to be registered
information to be collected
checks/balances to ensure that information is in fact obtained
determination of how/why information is to be used in the program process
creation of registration packet
pilot test process
implement process
fine-tune data for use in program
evaluate registration process
flow-charting is one way to visually depict a process (e.g. a picture is worth a thousand words)
good idea to build in some type of feedback mechanism so that people executing the process can explain where it could be improved
Danielson's comment: This is very similar to project management, with the added notion of improvement of the process
project management breaks tasks down to sub-tasks and deals with order of execution
project management deals with optimization of personnel involved in a task
Managing Change and Risk
note the difference between change and transition (Bridges, 1991):
change:
anything new - program, test, technology, etc.
external to the program
because it is new, it is often perceived as a threat (we don't like to change...as we get older we really don't like to change)
transition:
one's adaptation to change
internal to the person
in order to manage change, somebody usually has to give up something
how to manage change and transition:
determine what needs to happen (internally) for something to work
determine who will be affected, and how
sell that person on the change...(s)he needs to buy into the idea
establish mechanisms for affected people to explain how they are affected
help everyone understand the difference between change and transition
keep communications open while the transition is underway
ensure that people feel that they are able to voice their concerns...change is not just done to them
Document Improvement
note the speed with which we can forget...short-term memory lasts only minutes
write decisions down
all the time
in detail
for all people concerned/affected
in a language they will understand
circulate the document
archive the document so it will not be lost (cannot be lost!)
BEST PRACTICES FOR REENGINEERING PROJECTS
Best Practices in Reengineering (Carr and Johansson, 1995):
management support is necessary
publicize the need to change...create a win-win situation for all concerned
use any type of systematic process to guide the reengineering team
link project goals to program goals
integrate needs and desires of all clients
start with one project at a time...don't do everything at once...priorize
create a team to drive the process
document the important measures you change
make a careful plan for the change and transition...then execute
SUMMARY
reengineering involves everyone...it can't be done by a small group
use a "best practices" approach...let the best practices in the literature be your guide
EXAM REVIEW QUESTIONS
When worksite health promotion programs run into problems, there are a number of different strategies which organizations can take, reengineering being one of those strategies. Cox notes six other strategies which organizations can take. Briefly list and discuss what you feel are the most important four strategies. (4 points)
Briefly list six of the 13 criteria which Cox presents as indications of the need for health promotion program reengineering. (6 points)
What is "business process reengineering" and how is it related to worksite health promotion? (4 points)
Define and discuss the three components of reengineering according to Cox. (9 points)
Cox presents a number of "best practices" in reengineering (Carr and Johansson, 1995). In your own words, list and elaborateon any five of them. (5 points)
