Introduction. The making of best and constructive decisions in regard to the employee management, loyalty and satisfaction has been a challenge to many Information System Managers. In the recent past, best policies in regard to people management have certainly started to play a critical role in the growth and development of many business firms and are increasingly becoming popular. The reasons for this are not particularly hard to discern. Management Information System forms the most prized asset of an organization and there is need to attach the greatest effort towards their well-being for excellent performance. The central theme dominating this term paper focuses on challenges that face MIS in decision support such as technical and health challenges. The paper will, therefore, concentrate in health challenges in regards to achieving employee retention, satisfaction and improved performance. The increases in health care costs are placing considerable strains on the personal, corporate and government budgets. Powell, (2007), "OECD data show that over the past 50 years healthcare spending has increased by an average of 2 percent greater than the growth of GDP. If this continues, then by 2050 healthcare spending would, on average, absorb 20 percent of the GDP of most OECD countries compared to about 10 percent in 2006/07."
Worksite wellness programs differ in their interventions related to intensity, duration and comprehensiveness. The most popular programs include individual counseling, nutritional assessment and support, physical fitness, smoking cessation classes, back care programs, and stress management. Worksite wellness and health promotion programs are programs designed for employee participation to lead to healthier lifestyles and to prevent the onset of a disease or worsening of a disease. According to the Institute of Health and Productivity, the recommended health and productivity management model "directly relates health investment to a company's overall gain in productivity and profitability" (Reynolds, 2003). Although the benefits of worksite wellness programs have been extensively documented, some are more successful than others. One particularly complex issue is how to motivate employees to participate in the available programs at their worksite. Other contributing issues include employer costs and perceived employer benefits.
The purpose of the study was to examine the worksite wellness programs of the top 50 UK employers. The study specifically addressed the differences in the number and type of health promotion programs and services offered. In addition, employer costs for the services offered within the programs were reported.
Workplace wellness program in the UK
Between 1970 and 2003 total healthcare expenditures (public and private sectors) as a share of GDP in the UK increased from 4.5 percent to 7.8 percent. Several bodies have projected that this will continue to rise. A major setback in the struggle to bring down the costs of Medicare has been the "reactive" manner of response. As Reynolds, (2003) found out, of the $5000 per employee the average employer spent on health care in 2001, more than 95% was spent on diagnosis and treatment, with maybe 2-3% being invested in early detection (screenings) and no more than 1-2% in prevention. This reactive approach has continued to persist, even as evidence is made available that up to 50% of healthcare expenditures are lifestyle related and therefore potentially preventable. The provision of wellness programs and healthcare can also have profound benefits to the worker or the patient. Through these initiatives, the concerned person gets the motivation and incentive to get better and improve his well-being, when they get a better understanding of the need to maintain healthy behaviors and avoid self-destructing ones, given the potentiality of the risks. These believe is promoted by logical understanding that there are many benefits to be realized. In fact, companies are going to great lengths advocating the need for the individual employees to be the "owners" of their own health. This is seen as a monumental effort at trying to shift the "culture from that of treatment to prevention." It is seen that by shifting the passive health behaviors and adopting a more proactive stance, potentially sound outcomes can be generated. For example, a review of corporate wellness programs conducted by Reynolds, (2003) reported that comprehensive disease management programs yielded the highest return on investment. These findings advocate for health education, early detection and use of appropriate interventions as a strategy that can be deployed with tangible increases in investments on wellness initiatives. As observed, many companies now conduct health screenings at the office or plant site while others reimburse employees for the cost of annual checkups and other exams. This has been brought about by the realization that while early detection may cost $15,000 in surgical costs, the health care costs for the acute disease are much higher averaging $40,000 per incidence. A general concurrence on the need to improve health and wellness programs abides. The initiatives towards health care and wellness arises from the backdrop that preventive health care can act as a cornerstone on the basis of which efforts to reduce expenditures on health, enhance employees performance and improve on the bottom line results can be congregated.
While numerous studies have concluded that properly implemented wellness programs can improve employee health outcomes and have economic benefits and that worksite wellness programs have the potential to reduce absenteeism, increase productivity, and improve employee attitudes and job performance, it is apparently still that organizations are experiencing problems in successfully implementing wellness programs.
Literature Review Introduction
From an organizational perspective, the major question being raised is why providing health promotion or worksite wellness services? As an employer, what is the benefit to providing services that have not shown a return on investment? These are the questions this section will attempt to address by reviewing literature covering aspects of worksite wellness programs. Aspects of the wellness programs include motivators for the wellness programs, the health initiatives, successful implementation, impacts in the workplace and a cost-benefit analysis.
Employees' health status
The UK's government expenditure on health care has continued to rise over the past decade. From just under ?50bn spent by the state on health in the year 2000, which represented a sum of around 6 percent of GDP, expenditure on health has risen to 8.3 percent of GDP by the year 2008. This does not include private expenditures such private insurance and out of pocket expenditures for hospital care, primary care, dentistry, and non-prescription drugs. It does not also include expenditure on nursing homes, which should otherwise be included under the OECD definition of expenditure on health care. According to Powell, (2007), the inclusion of all these factors would mean that total expenditure on health care by the government would stand at more than 9.5% of the GDP. While the Overall expenditure on health by the government does not compare to the rest of the OECD countries and the US, the trends are nonetheless disturbing. The aging population, relative price inflation, supplier-induced changes, defensive medicine technological changes and expansions in health insurance covers have all been advanced as contributors to this observed phenomenon. Another factor has been the poor state of health of the Briton population and the prevalence of chronic illnesses. Indeed the WHO refers to "chronic diseases as the 21st-century healthcare challenge. The concept of chronic disease management is being promoted generally within the NHS in the UK and, for example, has been associated with a number of "key approaches" (Wellness Council of America [WCA], 2007). These have been anchored around disease management, in which multidisciplinary teams provide high-quality, evidence-based care that includes the use of pathways and protocols and secondly, self- care and self-management, where people are urged to take an active role in managing their own health and wellness. The Americans models of chronic disease management, such as those used by Kaiser Permanente and United Healthcare, have also been proposed. As can be expected, the high cost of health care has become an issue among all concerned stakeholders. With a layered understanding of the current environment and future expectations, members of the healthcare industry have been forced to re-evaluate their thinking towards more stringent policy formulation and adoption of mechanisms centered at arresting this phenomenon. The provision of healthcare and wellness programs in organizations has been cited as one of the remedies that can be deployed to help the rising costs of healthcare. Accordingly, therefore, because the work environment provides a stable setting and support system, wellness programs can have a great impact in lowering high-risk behaviors. The benefits to this in the opinion of Powell, (2007) are a direct reduction in health care costs, less rates of absenteeism, improved commitments and less short-term disabilities. For example, in patients with Type 2 diabetes who participated in a study by UKPDS, an 18% reduction in the cost of hospital admissions with intensive versus conventional blood glucose control was observed, mainly due to reductions in the length of stay.
A review of corporate wellness programs conducted by Powell, (2007) reported that comprehensive disease management programs yielded the highest return on investment. These findings advocate for health education, early detection and use of appropriate interventions as a strategy that can be deployed with tangible increases in investments on wellness initiatives. As observed, many companies now conduct health screenings at the office or plant site while others reimburse employees for the cost of annual exams. This has been brought about by the realization that while early detection may cost $15,000 in surgical costs, the health care costs for the acute disease are much higher averaging $40,000 per incidence.
A general concurrence on the need to improve health and wellness programs abides. The initiatives towards healthcare and wellness programs arises from the backdrop that preventive health care can act as a cornerstone on the basis of which efforts to reduce expenditures on health, enhance employees performance and improve company profits can be congregated.
Wellness Program Designs
Worksite wellness and health promotion programs have grown over the last decade and are becoming more popular outside the workplace, showing the ever-increasing importance of disease prevention and health risk management. According to Reynolds, (2003), private insurance companies, as well as state Medicaid and Medicare agencies, are working on ways to improve the health of the people they insure in hopes to save money. They are finding that employee health and wellness initiatives are cost-effective. As noted by Reynolds, (2003), high-risk employee behaviors contribute to substantial costs to employers and changing these behaviors is a strategy that can be deployed with positive and tangible outcomes on both the financial and general productivity of an organization.
Wellness programs include preventive initiatives aimed at changing lifestyle behaviors associated with greater risk of disease. According to the National Business Group on Health (NBGH) (2008), wellness programs may include health promotion and disease prevention programs which actively encourage healthy activities such as substance abuse control, weight management, smoking cessation, stress management and physical activity programs
Cost of Wellness Programs
Instead of cutting benefits or shifting costs to employees, more companies today are initiating worksite wellness programs as a way of controlling health care costs. Armstrong has found that 62 percent of large companies employing more than 200 employees and 26 percent of small-sized companies have initiated worksite wellness programs. Powell reports that companies not implementing wellness programs are generating negative returns on investment (ROI) (Powell, 2007).
Warner (1990) has classified the costs of successfully implemented wellness programs into three major categories, that is, direct, indirect and intangible costs. The direct costs include program startup and operating costs of personnel, supplies, facilities, equipment, management and the value of the time spent by employees while participating in such activities instead of working. Indirect costs include adverse future economic consequences such as higher pension and supplemental health insurance benefits for retirees who live longer as a consequence of successful health promotion. Lastly, the intangible costs relate to employees who perceive behavior change programs as an invasion of privacy. As contends, the direct costs of wellness initiatives and interventions appear to be low per employee or participant. This haven the promotional basis and the driving force behind the campaign to implement worksite wellness programs. However, as in the case of benefit analysis, limited research is discernible.
Most companies that are serious enough about implementing wellness programs recognize that a comprehensive program has multiple components to address all areas. The top components include training, resources, annual health risk assessment, consultants, and incentives. An information infrastructure is needed to communicate health care information, track participant progress, program evaluations and training schedules.
Cost-Benefit Analysis of Wellness Programs
The growth of business health care costs is clearly the driving force behind the linking of worksite wellness programs to cost containment. Business interest in health promotion can be categorized as economic, employee's health and welfare and the intangible corporate benefits. The centrality of concern for employee's health is logical. According to Reynolds, (2003), three interrelated premises underlie the perception that economic concerns are of preeminent importance, that is, the impact on the bottom line, the rising health care costs and evidence linking poor health behaviors and rising costs of disease incidence. In his opinion, a simple logical deduction follows in that, health promotion modifies behavior; improved behavior reduces health service usage and therefore health promotion services will help contain health care costs. As Reynolds, (2003) contends, the expansion of the employee's benefits, the aging of the workforce and growth in the retiree population have combined to exacerbate health cost inflation in the business community. It follows then that the company spending less on health care costs increases their bottom line.
Studies indicate that worksite wellness programs promoting healthy behavior may improve employee health, reduce absenteeism, increase productivity, reduce health care costs and increase employee morale (Powell, 2007). This study will evaluate worksite wellness programs of the top 50 employers in (your state) to identify the types of health promotion programs and services offered. The study will attempt to identify employer costs associated with worksite wellness programs in UK. The information identified in this study will be a resource for employers that have not implemented worksite wellness programs. The most frequently offered worksite wellness programs and employer costs of the programs will be available to employers.
Methodology Research strategy. Research strategy refers to the general plan on how the research questions that have been set will be answered. In this research paper, inductive research approach strategy was adopted. Here data was collected first and later the theories developed after data analysis was conducted. The approach owes more to phenomenology as opposed to positivism research philosophy. The research conducted was a clear case of a survey strategy, where a questionnaire was replicated and the items in the questionnaire measured. Due to the time constrains, the cross-sectional time perspective was followed. This is the case where a group (or groups)of individuals are composed into one large sample and studied at only one point in time, unlike in longitudinal time frame where an individual or groups of individuals are observed over a period of time. The case study research design was employed in data generation. He classifies case studies into four categories, namely, explanatory, descriptive and exploratory. Since we were aware of what we wanted to investigate but not aware of the answers, descriptive statistics was employed. Descriptive statistics approach involves describing a problem, context or situation. This can be said to be a feature of exploratory research as well, however, the questions posed are more descriptive, better structured and more reliant on prior ideas and methods. One would be more usually describing what is happening in terms of pre-existing categories, or relying on some other ideas borrowed from somewhere. It is important to state however the implications of what are being studied in detail.
Data collection mechanisms and procedure. Sampling strategy and sample sizes
The sampling strategy for any probability sample is a complete list of all the cases from the population from which your population will be drawn. There are several factors that must be borne in mind when determining the sample size. Some of these factors may include the importance of the decision, the number of variable, the nature of the analysis being carried out, the number of samples usually selected in similar studies on the same subject matter, the occurrence of behavior or characteristics in the population (the incidence rate), the resources constraints and completion rates. Researches in the business fields may especially be limited by time, money and expert resources resulting in the selection of small sample sizes. Probability sampling or representative sampling technique was adopted in the selection of samples as described by Reynolds, (2003). As a result, each individual stood an equal chance of being selected. The stratified sampling approach was followed. This ensured that all the important subpopulations were selected. Sampling was done in such a way that at least 50% of populations were chosen as sample.
In the selection of samples from the population, the confidence interval approach was adopted. The 95% confidence interval was taken. This means that if 100 samples are selected from the population, at least 95 of them would represent the characteristics of the population. The margin of error describes the precision of your estimates of the population. In this research, the 5% margin of error was applied in order to reduce the sample size.
Data collection methods. Questionnaires, standardized tests, observational forms, laboratory notes, and instrument calibration logs are among the devices used to record raw data. Survey research design will be adopted in the generation of primary data. Surveys are characterized by an organized or methodical set of data that is usually called a collection of variables. Collected data usually represents the same variables of multiple cases. Questionnaires should be designed to answer the research questions. In the quantitative data analysis approach, questionnaires should be constructed to collect answers from close or measurable types of questions so that data can be analyzed and presented to describe the characteristics. Furthermore, the causes of the specific phenomenon can be indicated and understood by investigating the variation and correlation in variables across cases (Reynolds, 2003). In survey research, the researcher selects a sample of respondents from a population and administers a standardized questionnaire document to them. Usually, the questionnaire is self-administered in that it is posted to the subjects, asking them to complete it and post it back The research design was chosen because it was possible to collect data from the large population under study. Information was generated by the use of the questionnaire administered to the respondents. The document had both open-ended and closed questions. Secondary data was generated mainly from the review of the available literature. This mainly involved reviewing library materials, past research works, the use of the Internet, management letters, brochures and memos, among others.
Data collection procedures. This is demonstrated further by graph data collection. From a review of the literature, a survey questionnaire was developed to collect data for the study. The questionnaire was issued first on a pilot project basis. According to Reynolds, (2003), the purpose is to refine the questionnaire so that the respondents will have no problem in answering the questions and there will be no problem in recording the data.