Wellness is not a Nicety; it is a Necessity. Building a Culture of Wellness: an Evidence-Based Approach

By Megan Amaya, PhD, CHES, NBC-HWC, AFAA-CGFI, The Wellness Strategy, LLC

It is widely known that the health of Americans is less than ideal. In addition to unhealthy lifestyle behaviors, mental health challenges such as anxiety, depression, and burnout continue to rise to epidemic levels¹,². Six in ten American adults live with at least one chronic disease; they are the leading causes of death and disability in America and driver of health care costs³.

Organizations have the unique position to address these challenges by building an organizational wellness culture and offering evidence-based health and well-being programs. A culture of wellness is defined as an environment in which stakeholders view wellness and well-being as a priority and collaborate to build initiatives to facilitate a healthy environment⁴. It makes engaging in well-being – healthy lifestyle behaviors and mental health care – the norm.

Implementation Strategies

A culture of wellness begins with leadership investing in resources that underpin the importance of well-being⁵ . Building a culture of wellness helps to improve population health outcomes, increases retention and student academic success, and yields a positive return and value on investment⁶. The effective practice of health promotion requires a shared responsibility of all to create change and a paradigm shift to one of prevention rather than treatment. A comprehensive approach to a wellness initiative is the foundation of culture change. It looks at problems and potential solutions through the lens of the entire system⁷. Operations, strategies, and tactics are identified and implemented for levels of the organization (e.g., managers, students). It is critical to use evidence and best practices to build a culture of wellness, to make healthier choices the easier choices. Innovation can certainly be built into programming and resources; this is encouraged. However, starting with established practices helps lay the foundation for strong, sustainable, and impactful initiatives to improve population health and establish a positive return and value on investment. This article outlines established best practices needed to create and sustain a culture of wellness.

• A multicomponent strategy to improve population health outcomes. This begins with a robust strategic plan, an exciting vision and mission, and proposed outcomes that are rigorously measured. The strategic plan should be vetted through various levels of the organization, particularly the leadership level, where resources are allocated. 
• An interprofessional committee whose function is to monitor outcomes of the strategic plan and make recommendations. 
• A wellness program framework or model to provide a robust backdrop for the wellness initiative. Examples include the Surgeon General’s mental well-being model⁸, Centers for Disease Control and Prevention’s (CDC) workplace health promotion model⁹, and/or various dimensions of holistic well-being (e.g. physical, emotional, financial, social)¹⁰.
• Leadership and management-level support. Evidence shows wellness programs are sustainable and better resourced when leaders and managers support the efforts¹¹. Leadership plays an important role in establishing the tone for wellness within an organization. Verbally supporting messages about why the organization invests in wellness, role modeling healthy behaviors, and permitting wellness activities to take place during the day are examples of how leadership can facilitate engagement¹². Leadership should be equipped with an annual report of health and well-being outcomes. 
• A needs assessment is one of the first things to do when designing a wellness initiative. The goal of a needs assessment is to obtain feedback, needs, barriers, and areas of opportunity from individuals who will be using the resources and services¹³. The inherent risk of not conducting a needs assessment is those who need and want the services may not use or know about them. A needs assessment helps take data to action; strategies, resources and programs are designed to meet the needs of the population. Ideally, an ongoing or annual assessment should be planned to help understand trends, barriers, facilitators, and motivators for quality improvement purposes. 
• Well-being and health policies and procedures that support employees and students need to be built into the structure of operations. Well-being policy is a set of cross-cutting actions that encourage healthy lifestyles and creates supportive environments. Policies and procedures should be individual and organizational level strategies to influence health¹⁴. Strategies may include a tobacco-free environment; the provision of healthy food in meetings; allowing flextime to attend well-being-related activities; and complying with occupational safety guidelines by maintaining a safe and clean work environment. 
• Resource allocation includes funding for programs, staff, physical space, access to clinical services, incentives, equipment, marketing and communication, and healthy food options, to name a few. Although a majority of the research on resource and capital allocation has been conducted in the fields of business and finance, the underlying notion of resource allocation in wellness underscores the value of health for all individuals¹⁵. 
• A well-developed wellness scorecard to track and measure population health outcomes and evaluate the wellness culture on a regular and consistent basis is one that will set itself up for success and sustainability. Continuous assessment helps to better meet the needs of the organization, assists with quality improvement, lends to a better understanding of program return and value on investment, and secures resources short and long-term¹⁶. 
• Wellness champions, known as peer support programs, are high-impact and low-cost. Peers provide social and emotional support to encourage adoption or management of healthy lifestyle behaviors and links to clinical care as well as resources and sustained behavior change services¹⁷. A wellness champion network helps support improved outcomes by using intrinsically motivated employees and students at all levels of the organization to increase participation in the wellness initiative, promote a culture of wellness and impact healthy lifestyle behaviors. Wellness champions have the capacity to tailor wellness programs to meet the needs and characteristics of their colleagues, workgroups, classrooms, and clinical environments. 
• Partnerships and collaborations can enhance wellness efforts. For a partnership or collaboration to be successful, it is key to ensure a common vision with goals that align. Partnerships and collaborations may be internal, with departments and groups that have a vested interest in wellness, such as an insurance/health plan, human resources, and student services. Partnerships and collaborations also may be external with local, state, and national organizations. 
• Effective, regular and consistent communication is a vital component of the overall initiative and fosters an organizational commitment to well-being¹⁴. A communication plan helps increase awareness and recognition of the program and program participation, improves health-related behaviors, refutes myths and misconceptions, and educates students and employees on the organization’s position on a health issue or policy. Communications targeted to increase emotions in individuals is especially useful in helping people to contemplate making a behavioral change. Assessing how best to communicate can help program facilitators understand how to better reach the intended audience(s). Assess the health literacy of communication materials. Health literacy incorporates a range of abilities, such as reading, comprehension, and analyzing information; deciphering instructions; weighing risks and benefits; and, ultimately, taking action. Using health literacy builds trust and advances health. Using plain language, the audience’s preferred language and communication channels, and appropriate language, is recommended. 
• A variety of options that appeal to different interests will lend to the success of the wellness initiative. Programs, resources, and services that encompass one or more dimensions of wellness, focus on different levels (e.g., individuals and social networks), include fundraising opportunities (e.g., American Heart Walk), family-oriented events, virtual or in-person, educational, behavior tracking, or health coaching are all examples of programs and services that contribute to a wide range of opportunities, different audiences, and varying levels of interest. 
• Incentives that are considered of value and worth can motivate and encourage employees to participate in wellness program resources and services. In a 2019 study¹⁸, the authors found that preferences for incentives to engage in different types of healthy behaviors differed by employees’ socioeconomic and demographic characteristics. Incentives can include gift cards and other monetary enticements, fitness and wellness equipment and apparel, sporting tickets, and discounts on insurance premiums, for example. To best meet the needs of program participants, collect input from stakeholders on what kinds of incentives are of value, and how much incentives motivate individuals to participate and engage in programming. 
• The physical environment can facilitate or discourage well-being. The average American spends approximately 87% of their time indoors and an additional 6% in an enclosed vehicle¹⁹. The physical environment can significantly influence quality of life. There are many design and operational factors that affect how a building meets occupants' needs: thermal comfort, indoor air quality, visual comfort, and acoustic comfort are four primary indoor environmental quality factors are strongly linked with occupant health and productivity²⁰. Healthier food options near decision-making points improve food choices. Locations can have dedicated bulletin boards or (electronic) displays that promote health management activities. AEDs and other emergency services (e.g., Naloxone kits) can be located in high visibility areas that are accessible to everyone. Making small changes in the physical environment can have a significant positive impact on well-being. 
• Familiarize employees and students to the wellness initiative during orientation or on-boarding introduces prospective participants to the initiative, the overarching goals, the importance of building a wellness culture, self-care, resources and programs. 

Getting Started

Understandably, not all organizations are to the point where they can implement all of the best practices. Program staff need to understand and appreciate which elements can be executed in the shorter term in order to begin creating a culture of wellness, while discovering and delivering what is appropriate for the current environment. Determine which practices are the most realistic and feasible to implement first and work on potentially more challenging aspects over time. Experiencing positive outcomes and small wins along the way pave the road for more advanced practices. 

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Dr. Megan Amaya is an Associate Clinical Professor and the Director of Health Promotion and Wellness at The Ohio State University. She is founder and owner of The Wellness Strategy, a wellness consulting firm. Dr. Amaya is co-director of the Bachelor of Science in Health and Wellness undergraduate program and principal investigator on multiple health and wellness research projects. She is a certified health education specialist, board-certified health and wellness coach and certified group fitness instructor.

Email: [email protected]