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'Do your homework' for EH business plan
Why should your hospital invest in employee health and wellness? Answer that question in a detailed business plan and you may win support for your programs from hospital leadership.
At Tampa (FL) General Hospital, JoAnn Shea, MSN, ARNP, director of employee health and wellness, presented a business plan for an expanded wellness program and fitness gym that gained favor from the hospital's administration. She demonstrated the return on investment and impact on health care claims information that justified the additional expense.
"You have to do your homework and take the time to write [the plan]," says Shea. "You can't just go in and say, 'This is what we need.'"
Physical space turned out to be Shea's most challenging issue. The current gym is too small to meet employees' needs, and she identified a former rehab gym that already has a shower facility and required minimal renovation. But the hospital also needed space for additional meetings rooms and to house an electronic medical record system.
Shea's plan includes the square footage needed, the equipment, and design. She offered three options - a bare-bones proposal, a midrange, and a premium version. New equipment would cost from $26,000 to $57,000, not including the $16,000 grant expected from the hospitals' foundation. "If you give options, they're more likely to give the middle of the road than nothing," says Shea.
At least some additional equipment is essential to attract the members, she told management. "Option 3 [with the most new equipment] would be great, but Option 2 is what we're looking for," she says. Renovation would cost $51,500. To help fund ongoing operating costs, including additional fitness staff, she proposed raising fitness center membership fees for employees from $35 per year to $130, or $5 per pay period.
Shea presents her case using the SBAR approach: Situation, Background, Assessment and Recommendation. Here are some steps she took in outlining a business strategy:
Present the facts about your current situation. "The current fitness center membership has exceeded the capacity of the 605 square-foot facility and cannot serve potential members from the current population of 5,800 employees," Shea told hospital leadership in her business plan.
Fewer than one in 10 employees (503) are members of the fitness center. Employees who decided not to renew their membership said the wait for equipment or showers was too long, the equipment was too crowded, and the exercise classes (held in a different location) were inconvenient. They also wanted secure storage space for their belongings.
Moving to space in an office building on the hospital campus would increase the square footage to 3,500 sq. ft. and accommodate up to 1,500 members.
Provide some broader perspective on your needs. Shea gathered a variety of information that bolstered her case for improved fitness facilities and more staff. The spacing around the equipment did not meet the standards of the American College of Sports Medicine. Fitness facilities at other area (competing) hospitals range from 5,000 sq. ft. to 30,000 sq. ft.
Meanwhile, medical claims for employees reveal a gap in preventive health and a potential benefit from expanded wellness services. Information from the third-party administrator of the health plan, United HealthCare, showed that 3% of employees have heart disease and incur 16% of the medical costs. Only about 44% of employees with diabetes received their recommended blood glucose tests and only 34% received their recommended eye exams.
Hospital employees also suffered from depression and asthma at rates significantly higher than the norm, according to United HealthCare data.
Health care claims data provide valuable support for wellness, says Shea. "These are things we could bring to management and say we need to work on this," she says.
Give the business justification. Shea did some research and found that employee wellness programs have a return on investment of $3.60 to $7 for every dollar spent. She cited studies that link poor lifestyle and personal health behaviors to absenteeism, presenteeism (lower productivity on the job) and higher medical claims. Her sources included the Work & Health Research Center at the University of Maryland School of Nursing in Baltimore (nursing.umaryland.edu/excellence/ whrc/index.htm) and the Institute for Work and Health in Toronto (www.iwh.on.ca).
Shea also solicited proposals from four outside vendors who would contract to manage the fitness center. The highest bid was $267,264 and the lowest was $210,700. Shea's proposal totaled $155,504 for staffing and operating costs.
To arrive at her costs, Shea spoke to the facilities director and biomedical engineers, who maintain the equipment. She also worked with the vendor of fitness equipment to evaluate what would fit.
Provide information in multiple formats. Shea needed to have all the details worked out, but she also needed to present the options in a quick and easy format. She created a comparison chart and a PowerPoint presentation.
"We present in a simple fashion and give them additional details in our printed proposal," Shea says. "Very few people want to read through the whole thing, but they may ask a question and you have to have the information. They expect you to do a thorough job."
Be willing to stick with a good idea. Don't be discouraged if you don't get approval the first time you present your plan. After all, hospital leadership must balance competing needs and limited resources.
Shea presented a proposal for an injury prevention program five times before she won approval. "You can't feel defeated," she says. "You need to keep being persistent, professional, and positive and eventually you get there."