Results from phase one focus groups

Contents

• Executive summary
• Methodology
• Study
• Background
• Further Discussion
• Alberta Blue Cross^®
• Appendix

Methodology

Focus groups were chosen for data collection to gather in-depth information from a variety of perspectives in response to exploratory research questions. Eight focus groups were interviewed with each group consisting of five or six employees from the same company.

Participants consisted of employees of various positions from small- to mid-size Albertan companies. Companies were chosen carefully to ensure equal representation of both those that have successfully implemented a corporate health and wellness program and those that have not.

A semi-structured questioning route was used to moderate the focus group. The questions included opening, introductory, transition, key and ending questions. Each focus group session was audio recorded and transcribed verbatim to document the participants’ verbal responses. Once the data were sorted into topics, direction and compared against ideals, the data was analyzed to identify potential recommendations for implementation of a successful program.

Key learnings

Through close examination of the study findings and participants’ responses, four key learnings have been identified. In addition to these learnings, we have included the significant facilitators and barriers related to the learning as identified in the results and discovered through our own wellness implementation experience at Alberta Blue Cross^®.

The focus groups were familiar with what employer health benefits are and whether their organization had them. However, many of the focus groups were unfamiliar with wellness programs in general or if their company had one. From these findings, we inferred that employees need to be educated on the definition and purpose of wellness before engaging in wellness activities. The desired outcomes and the link between wellness and company strategy must also be communicated

Barriers

• Lack of an understanding of wellness, workplace culture and corporate wellness.
• Lack of a clear communication strategy to educate and engage employees in existing wellness programs and their role as ambassadors in the organization.
• No baseline data to determine information gaps that employers can address with their employees.
• Employees see wellness as something being done to them rather than something they are a part of.
• Senior leaders are not clear or aligned on the purpose of wellness as an integrated part of their organization.

Facilitators

• Varied communication content and methods to reach and influence a diversity of employees.
• A wellness strategy that clearly communicates the link between wellness and company goals.
• Company leaders modelling wellness behaviours, supporting a wellness-focused organization and clearly defining what wellness is and the outcomes to be achieved.

A COVID-19 perspective

While Alberta Blue Cross^® had an established wellness program before the pandemic, it was important to ask what does corporate wellness mean for our employees amidst a pandemic? As per key learning one, we needed to not only quickly rethink the meaning of wellness but look at new ways to communicate and engage our employees on the topic

Leveraging our established wellness theme Better Together, we built a wellness campaign specifically targeting pandemic issues: self-care, tips and tricks, stress management, health care and even online counselling were made available. Specific COVID-19 resources and supports were added to Balance^®, our online wellness platform. We then focused on ways to inform our team members about the new resources and wellness priorities. We shared ongoing communications through weekly employee emails from the executive team and posted updates on the company intranet to inform employees of events, campaigns, resources and supports.

Noteworthy are the weekly phone in town halls, where our CEO shared organizational priorities during this time, the first and foremost being the care and well-being of our employees through this transition and doing whatever it takes as an organization to support employee well-being.

A successful wellness strategy depends on input and engagement from all levels within the organization. Employee input is vital to the long-term success of a wellness program. The earlier employees are involved in the development of the program, the more likely they are to engage. Leadership must actively show buy-in by modelling wellness behaviours to encourage adherence from the rest of the organization and develop a wellness champion mindset in everyone.

Barriers

• Top-down approach to communications.
• Lack of buy-in from leadership.
• Lack of a communications strategy.
• Communications methods used are inappropriate or don’t reach the audience.
• Employees don’t feel empowered or like they have permission to focus on wellness.
• No opportunity for employee feedback through focus groups, surveys or other methods.

Facilitators

• Regular review and evaluation of wellness strategy to ensure employee needs are being met.
• Time and expertise dedicated to developing wellness programming.
• A wellness champion culture where everyone feels they are part of the wellness ecosystem.

A COVID-19 perspective

At the best of times, two-way communication can be difficult to foster. With 98 per cent of Alberta Blue Cross^® team members working from home, impromptu drop-ins and face-to-to-face checkins were no longer a possibility. At the same time, with mounting anxieties and feelings of isolation, employee feedback and two-way communication was even more critical.

Departmental surveys focused on wellness were made available to ensure all team members had the opportunity to share feedback. The aggregate feedback was shared with managers so they could champion and resource accordingly to meet the needs of their teams. By better understanding what was working and not working well as we transitioned to work from home, mangers could be part of the resolution rather than recycling ongoing problems and inefficiencies

Virtual mental health booster sessions were made available for managers. These sessions not only supported their well-being but helped them foster positive and productive team member check-ins so they felt heard. In this fashion, all team members were provided with adequate supports and resources. Suggestions from these initiatives were brought to relevant internal stakeholders to start conversations around change management, resourcing, necessary supports and more.

Wellness strategies must be tailored to the needs, concerns and lifestyles of employees. Programs need to be accessible and adaptable to different work styles, such as work-from-home, part-time and seasonal. Programs should be varied in activity and topic to meet the health and wellness concerns of employees. Organizations need to consider providing a range of rewards to keep employees engaged and motivated. Along with extrinsic rewards, intrinsic and interpersonal rewards, such as decreased stress, a general sense of well-being and enjoyable social interactions with colleagues, should be considered and made accessible.

Barriers

• Variable geographies, worksite locations and work types.
• Employees that are ineligible for benefit or wellness plans due to work type, such as seasonal, hourly, casual or contract workers.
• Lack of dedicated time for employees to devote to wellness during work hours.
• Technological limitations including employee familiarity with virtual tools.
• Abundance of information and confusion on best practices.
• Unaware of intrinsic and extrinsic behaviour change motivations.
• Siloed thinking.

Facilitators

• Input from all employee types when developing strategy and facilitating a variety of wellness programs.
• Multiple stakeholder input throughout strategic and operational planning.
• Program flexibility.
• Fostering intrinsic rewards and a culture of inclusivity.
• Established vehicles for education, information and ongoing communication.
• Change management considerations.

A COVID-19 perspective

With the adoption of working from home, it was important to support team members who had less virtual experience. Our wellness department worked closely with internal teams to provide feedback on relevant training needs, such as WebEx, OneNote, staying organized and how to utilize change management techniques to ensure smooth transitions. Providing training on how to navigate a virtual environment and related platforms like Zoom and WebEx helped mitigate fear and increase engagement not only in wellness programing but work in general.

Understanding the benefit and reward of social activities, existing in-person social groups were moved to virtual platforms. For example, our games group and Spanish club are now virtual. However, understanding that virtual platforms cannot completely replace in-person connection, we developed several socially distanced friendly events for individuals to participate in such as outdoor walks.

Wellness initiatives focused on a single aspect of wellness are less likely to make an impact. The most successful wellness programs should address physical, social, financial and mental well-being. It is important to note that without addressing mental health, the other health-promoting behaviours are likely to be neglected. Corporate wellness strategies should make mental well-being a primary target as employees are unlikely to partake in other wellness strategies if they are suffering from mental health issues, such as burnout, anxiety, lack of support, no access to adequate resources or stigma related to mental health.

Barriers

• Lack of understanding about holistic wellness and how mental health, financial health, physical health and social engagement impact each other.
• Lack of a framework to understand where, why and how wellness fits in a larger ecosystem to include strategy, operations, communications, metrics and environment.
• Stigma associated with mental illness.
• Unaware of supports and resources available.
• Focusing too much on treatment versus prevention.

Facilitators

• Good work-life balance.
• Open and safe communication.
• Ensure mental health is a key pillar in a comprehensive wellness strategy.
• Provide mental health training for all employees.
• Ongoing campaigns and communications strategies that reinforce a company’s message and how they support mental health.
• Partnerships with other provincial and government organizations that can support mental health.

A COVID-19 perspective

To continue the success of our wellness programing during the pandemic, it was imperative that we address the emerging needs and concerns of our teams. Existing educational sessions, such as nutrition and psychology lunch and learns and financial oneon-one sessions, were made virtual and COVID-19 related materials including health tips and coping with stress were accessible online. We continue to add resources and tools with the understanding that employees across the organization require different types and levels of support as we continue to navigate through this unprecedented time.

Prior to COVID-19 Alberta Blue Cross^® had placed a priority on mental health. In late 2018, Alberta Blue Cross^® leadership made mental health training mandatory for all team members with training beginning in 2019. This high prioritization of mental health support in the workplace continued in 2020 with six sessions of Mental Health Commission of Canada’s The Working Mind training in the first quarter—bringing the total portion of Alberta Blue Cross^® team members trained to over 80 per cent. Further training was impacted by COVID-19; however, with new virtual options now available, we will begin offering additional training sessions in early 2021 and ongoing as part of our new employee onboarding plan. With the added stress and anxiety of the pandemic, the mental health of our employees became even more important. As stated previously, we have an open invitation to all managers for 20-minute mental health booster training sessions to provide continued support, information and updates. We partnered with outside resources to provide additional mental health resources such as text4hope and free access to Stronger Minds by Beacon^® an online mental health portal. Through ongoing partnership with our communications team, we are developing a communications strategy that reinforces our commitment to mental health and supports.

Background

Just over a quarter of company health care costs are due to modifiable, lifestyle-related health risks such as physical activity, stress and blood pressure (O’Donnell et al., 2015). Chronic health conditions are on the rise across all age groups. These conditions create major sources of lost productivity in the workplace (Loeppke et al., 2007) and increase health-related expenses in both direct medical payments and indirect costs from absenteeism and presenteeism (Anderko et al., 2012, Burton et al., 2006, Goetzel et al., 2008, Loeppke et al., 2009). One suggestion to help alleviate health-related costs and improve company performance is to invest in corporate health and wellness programs. But do these programs work?

Extensive evidence indicates that well-designed, evidence-based health and wellness programs within a supportive culture are successful at

• decreasing health care-related costs for the company and the employees (Naydeck et al., 2008),
• increasing employee productivity (Mitchell et al. 2013, Lerner et al. 2009),
• improving health-related outcomes,
• changing lifestyle behaviours (Mattke et al. 2013),
• lowering employee turnover (Isaac 2010), and
• improving overall economic performance of the company (Goetzel et al. 2019, Isaac 2010).

Despite these benefits, many companies have not yet implemented corporate wellness programs. As stated in the executive summary, Alberta Blue Cross^® has a long history of implementing wellness programing both internally and supporting other organizations. Overtime, we have developed insights on the benefits of a wellness program to an organization, as well as the barriers and facilitators companies face when adopting or implementing a wellness program of their own. This study was commissioned to build upon learnings and challenge the assumptions we have garnered over time. This will allow us to improve the wellness of Alberta Blue Cross^® team members, but help us support our customers in developing their own wellness programs.

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Purpose

This study has two main purposes:

1. to look at the factors that promote and inhibit the implementation and uptake of wellness programs within organizations; and
2. to strengthen current knowledge and understanding of the relationship between health and productivity, as well as the cost-benefit ratio of wellness initiatives within the workplace.

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Methods

Participants

Study participants were purposefully chosen from leadership, human resource professionals and employees from small- to mid-size Alberta companies. The aim was to have equal representation between companies that have successfully implemented corporate health and wellness programs and those that have not. Companies were initially invited to participate by their health benefits provider, and all subsequent communication with study participants was through members of the research team. Ethics approval was obtained from the University of Alberta Human Research Ethics Board.

Data collection and analysis

Focus groups were chosen for data collection for this study as they allow collection of in-depth information from a variety of perspectives in response to exploratory research questions.

Focus groups were particularly useful in this study because participants were asked to discuss the complex nature of health and wellness programs within their companies (Gill et al., 2008).

Participants were emailed informed consent forms prior to the focus groups. At the beginning of the focus group, participant consent forms were collected, and participants were provided with a verbal explanation of the study with opportunity to ask questions.

Eight focus groups were conducted, each with five or six participants from the same organization. Once the data were sorted into topics, direction (negative or positive) and compared against ideals, the data were analyzed to identify potential recommendations for implementing a successful program. Multiple potential recommendations per participant were identified in each of the focus groups, so the recommendations were grouped whenever possible. Recommendations were contextual to the organization, making the development of a singular solution challenging. The researcher also flagged specific suggestions for implementing recommendations.

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Results

Awareness of corporate wellness initiatives

Lack of awareness was common when participants were asked about their current wellness program, most often because their companies did not have a wellness program or participants were unsure if their company had one. This is highlighted in the below comments:

Tailoring communication, not just in content but in delivery methods, was also highlighted. How do employees obtain information? Are they reading emails? Checking Facebook? Reading notices on a board?

Recommendations

Clear communications to all employees regarding wellness are required on a regular basis. These communications should

• define what wellness is and why it is important both to employees and to the organization;
• delineate wellness into areas of focus for the organization (such as physical wellness, financial wellness, social wellness, mental health);
• identify the company’s and leadership’s commitment to employee health and wellness; and,
• identify existing resources employees can utilize to improve their health and wellness.

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Input and engagement

Input from all levels is necessary for a successful wellness strategy. Focus group participants agreed that the best place to start is to have an organizational strategy for wellness. Communication about a wellness strategy and program is paramount both in terms of advertising offerings, as well as the ability for employees to provide feedback on the offerings. If decisions about a wellness program are made without employee input, it is less likely to get uptake among employees and will therefore be less successful.

The majority of the focus groups agreed that the leadership needed to not only buy into wellness programs, but also be able to influence and model behaviours in order to achieve higher adherence from the rest of the organization.

Constant evaluation of wellness programs and being open to feedback were also mentioned as being highly important.

Recommendations:

• Create a company wellness strategy that
  • aids in information program development and increases buy-in;
  • ensures the program is linked back to the purpose and direction of the organization; and
  • collects input from the all levels of employees, which aids in program design, employee participation and improving outcomes.
• Offer the opportunity for employee feedback and measurement of program effectiveness.
  • Offer the opportunity to make necessary changes to improve programs and for financial investment of the company and time or financial investment of employees.
• Offer education to leaders on how they can support and model the wellness programs to increase program participation.

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No one size fits all

Focus group participants expressed that it would be difficult for large organizations with a diverse workforce to adopt a wellness program. They agreed that all employees deserved wellness activities, but that employees would rarely benefit equally from them. Several focus groups recognized that many employees (seasonal, hourly, casual, contract, etc.) do not qualify to participate in any benefit plans, even though they play an integral role in the organization. In terms of flexibility, they questioned what could be offered to those who do not qualify for regular benefits. Participants expressed that any attempt by an organization to organize events or activities without considering employee needs was pointless.

Recommendations:

• Personalize wellness program offerings to employees, their needs and their lifestyles.
• If there are different generations and working structures (shift work, contract, seasonal, etc.), consider offering a variety of options to maximize impact.

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Whole health

A greater ability to balance work and life would increase wellness overall. Wellness initiatives solely focusing on either monetary contributions or activities related to a single aspect of wellness were unlikely to make much of an impact on employee wellness.

Several groups mentioned that people were already overworked, overburdened and not taking their breaks, so it would be unlikely that they would take part in wellness strategies (such as going to the gym at lunch), even if it was encouraged or paid for by the organization.

A COVID-19 perspective

As stated in the summary we would be remiss if we didn’t acknowledge the impact COVID-19 has had on our people and organization and how it has impacted our understanding of the findings of the study.

As our organization adapted and transitioned to meet the challenges of the pandemic the learning from the study took on new meaning and significance. Perhaps most significant was how having a well-established internal wellness program in advance of the pandemic provided organizational stability during the pandemic. Through existing wellness channels, we were able to provide important COVID-19 information and resources to employees in a timely and efficient manner.

In early 2020, Better Together was chosen as our wellness theme based on internal conversations, DECEMBER 2020 16 evaluations and awareness of the need for social engagement and the power of unity and collaboration. Better Together became even more apt moving into COVID-19 when within one week, 98 per cent of Alberta Blue Cross^® team members started working from home, facing unanticipated stressors such as isolation, loneliness, economic uncertainty and fear of the unknown. It was important that our consistent messaging stated that we are in this together, no matter what.

First, the internal wellness team adjusted priorities to deliver virtual resources in a timely manner by working closely with other internal teams to develop virtual resources and remote access. Leveraging our theme, we then began introducing new virtual wellness tools to team members for continued accessibility and to support our efforts to keep our people well.

When implementing any program, it is important to consider the experience, knowledge and skill level of all employees. While some of our team members were already familiar and comfortable with online tools, we quickly realized that others would require training to access virtual wellness supports and perform regular work duties during the pandemic. Providing different options to access materials and training on how to use the platforms helped mitigate fear and increase engagement. Wellness programs and updates were provided through multiple vehicles, including online live sessions, videos, blogs and through regular phone-in town hall sessions.

As the study results showed, wellness programing must be relevant to individuals’ needs and concerns. Wellness concerns shift dramatically during a crisis like the COVID-19 pandemic, making it important to shift wellness content to meet the new and overwhelming concerns of employees. Building a wellness campaign specifically targeting pandemic issues, such as self-care, tips and tricks, health care and even online counselling, allowed Alberta Blue Cross^® to support our people, plan members and all Albertans. Specific COVID-19-friendly resources and supports were added to the Balance^® platform for internal team members and clients. New materials and regular updates were provided to our teams through a variety of virtual channels as the pandemic situation evolved. We also increased efforts to support Albertan’s health by offering wellness videos and blogs on social media as well as supporting unique programs such as text4hope, free access to Stronger Minds by Beacon.

Leadership buy-in is vital to the success of any wellness program. This is even more true during times of organizational uncertainty and change such as the pandemic. Alberta Blue Cross^® team members had access to leadership through weekly phone-in townhall sessions where leadership would provide current information. They were also able to submit anonymous questions before the meeting and we are currently piloting a tool to allow live questions.

Pre-existing emphasis on mental health prior to COVID-19 undoubtedly fostered the emotional intelligence and healthy language individuals needed to discuss concerns in the unfolding situation. The second and third quarters of 2020 presented opportunities to evaluate and assess the ways in which our Alberta Blue Cross^® culture of wellness helped us sustain team member engagement, disseminating information and providing access to key resources during the pandemic.

Throughout the study, social activities were identified as one of the top rewards identified by participants and an important part of employee wellness. However, moving 98 per cent of team members to work from home and maintaining social distance requirements meant staff events, impromptu or planned, was no longer an option. At the same time, finding ways to keep coworkers connected socially became even more important as we faced mental health issues related to isolation. It was imperative to find new ways to provide social interactions. As much as possible, we have transitioned existing social groups to virtual platforms. However, virtual platforms cannot wholly replace in-person connection. As a result, we developed several regular socially distanced friendly events for everyone to participate in.

Significant work done in response to COVID-19 aligned with the existing internal roadmap. For example, projects planned for the latter half of 2020, such as wellness supports for work-from-home team members, became immediately relevant, and their early execution allowed for unanticipated expansion and improvement in future quarters.

Furthermore, the internal wellness team is prepared to leverage positive changes in our return to on-site work and how this can be addressed from a wellness perspective. Specifically, increased comfort with using virtual technology widens the potential for robust wellness offerings now and in the future, such as enhanced on-demand wellness break resources.

How Alberta Blue Cross^® can help

We are experts at helping organizations build and implement wellness programs that benefit both employees and your organization: Alberta Blue Cross^® provides access a key resource to assist companies in communicating with their employees:

1. Online Balance^® toolkit—this free wellness toolkit is available on our plan administrator website and includes resources such as
   • Balance^® communication posters,
   • email templates for
     • invitation to log into Balance^® and
     • privacy and confidentiality concerns.
   • PowerPoint presentations,
   • Balance^® employee handouts and FAQs,
   • monthly wellness plans, and
   • sample employee survey.

We are continuously exploring and developing new and innovative wellness solutions such as our organizational wellness assessment tool.

Appendix

Table 1: Focus group questions