Program follows holistic path to caregivers’ health
Approach emphasizes psychological well-being
An Iowa hospital system has adopted a holistic approach to its employees’ health that integrates spiritual and physical health and encourages individuals to realize their potential for growth, health, and enjoying life. And health care providers who feel well themselves impart a greater sense of well-being to patients. (See Patient-Focused Care, June 1999, p. 61, on the relationship between staff and patient satisfaction.)
The program, called Kailo (an Indo-European word meaning to be whole or healthy), applies a somewhat offbeat approach toward fostering the well-being of the staff at Mercy Medical Center — North Iowa in Mason City. Mercy Medical Center is a nonprofit hospital system employing about 2,700 people at more than 60 facilities in 16 counties across northern Iowa. The organization is the largest employer in Cerro Gordo County and the largest employer of women in northern Iowa.
Staff health needs surveyed
But where did Kailo come from? Nobody at the organization had ever heard of the word when the hospital’s director of women’s services launched a research project early in 1996 to find out how employees perceived their emotional and physical health.
The results, based on the responses of 253 female employees who completed an augmented version of the standardized Adult Health Risk Survey, revealed some interesting findings about Mercy’s staff, as well as some troubling ones:
• Nearly 90% of employees were female.
• Twenty-five percent of age-appropriate women had never received a mammogram.
• Forty-four percent of female employees met the definition of clinical obesity.
• Seventy percent did not exercise regularly.
• Fifty-seven percent reported high or very high stress in their lives during the past six months.
• Half reported at least one episode of depression in the previous six months.
• Nearly four in 10 women said their body shape and size interfered with what they wanted to accomplish in life.
• One in five reported being the victim of verbal or physical abuse in their homes (which is actually lower than the national average).
In focus groups, female employees said they were more concerned about psychosocial and spiritual health concerns than they were about nutrition and fitness. "Women were talking about parenting, getting along with co-workers, fatigue, sleeping problems, depression, and stress," says Kelly Putnam, MA, Mercy’s health promotion coordinator. Employees wanted to feel valued for who they were, not just what they did at work; and they wanted more fun and playfulness on the job, she added. Employees also said a lack of time and supervisors often kept them from participating in a wellness program.
Clearly, a health promotion model centered on reducing risk factors for disease would do little to address the concerns of Mercy’s staff. They needed something different.
In the summer of 1997, Putnam attended a holistic health seminar presented in Stevens Point, WI, by Jonathan Robison, PhD, MS, executive co-director of the Michigan Center for Preventive Medicine in Lansing. Robison discussed holistic health models that appeared to be just what Mercy was looking for. Putnam also picked up the word "Kailo," which seemed to her like a perfect name for a health program.
Eliminate the negative
Traditional health-promotion programs in this country are based mainly upon a biomedical, mechanistic principle, Robison explained. They stress causal links between behavior, disease risk, and premature death, and preach abrupt alterations in behavior in order to avoid ill health (lose weight, reduce blood pressure, eat less fat, exercise more, etc.). The messages, says Robison, are almost always negative, rarely life-affirming, and are based on the assumption that people naturally gravitate toward unhealthy habits.
Holistic health models give equal weight to psychological well-being and physical health, yet do not discount the importance of healthy behaviors. They do, however, reject the view that the human body is a complex machine that operates smoothly (or breaks down) in response to "mechanical" maintenance.
Instead of trying to dictate behavior, holistic programs take aim at the universal factors that underlie and influence behavior, such as relationships, self-image, social support networks, meaningful work, emotions, optimism, playfulness, creating an understanding of life’s important issues, and fostering awareness of a person’s value, strengths, and potential. Their messages are positive, not negative, says Robison.
"People are tired of messages that tell them that they’re going to die because they’re not doing the right thing," she continues. "The focus on negative messages has become a barrier to participation in health programs.
"To make a health program work, you have to bring down those barriers. You want people to say, Why wouldn’t I join this,’" she says. One way to attract more people to health programs is to eliminate stressful elements such as fitness tests and minimize the commanding tone that usually does little to modify behavior, Robison says.
Guided by Mercy’s survey results, Putnam and her colleagues combined what they learned at Robison’s seminar with information from the Stone Center at Wellesley College in Wellesley, MA, whose research shows that women experience their life and health through their relationships. The result was the Kailo program, which kicked off in January 1998.
Take a Kailo break
The first element of the new wellness program was the Kailo break. Each of these hour-long programs focuses on a different aspect of health. At first, topics were kept light and entertaining. The speaker at the first Kailo break recounted the adventures of his seven cross-country treks. Clowns, jugglers, and magicians often appeared at Kailo breaks. "We wanted to show employees that we didn’t expect anything from them," says Putnam.
The hospital encourages, but never requires, employees to attend Kailo breaks, and even pays them for their time based on salary, even if that entails overtime pay. Meals are also served. Each Kailo break is repeated nine times throughout the month, giving employees numerous opportunities to attend.
Setting up Kailo on company time and on the company’s dollar makes the program inviting to employees, Robison says, adding that the payback to the employer is hard to dispute, because people who feel good about their work and workplace are more productive. "The research is clear on that," he says.
As Kailo breaks entered their second year, the programs gradually broached more serious topics such as sleep deprivation, body image, workplace violence, stress, and spousal abuse. But the program coordinators still tried to keep the mood light.
In May 1999, Mercy began Kailo-For-One, which allows employees to meet with a social worker hired solely for the Kailo program. Mercy places no limits on the number of appointments an employee can make. "It’s a customized wellness program that people can use to address any issues at all," explained Putnam.
Putnam reports that the response has been tremendous, with an average of 30 to 40 sessions each week. "I wouldn’t recommend starting a wellness program off with this type of activity," Putnam pointed out. "First, we had to build employee trust so that they would be willing to take this next step."
From the inception of Kailo, Mercy’s administration consistently allocated the resources necessary to build the new employee health program, according to Putnam. Without such a strong level of commitment, Kailo might never have gotten off the ground. "We’re sort of unusual in the level of support that we’ve had," she says. "[Administrators] even make presentations at some of our programs. We have the budget and adequate staffing. I think a lot of companies won’t or can’t make that kind of commitment."
Follow-up survey planned
Shortly after the start of the Kailo program, Mercy gathered baseline data from more than 1,400 employees to determine their current health habits. Beginning in January 2000, Mercy will survey the respondents a second time to monitor the progress and the effects of the Kailo program. "We’re very eager to see how we’ve done. The results will help us determine our next step," Putnam says.
In 1998, Mercy was awarded a Best Practice Citation from the Joint Commission on Accreditation of Healthcare Organizations, and in October the hospital received the Gold Well Workplace Award from the Wellness Councils of America, a distinction given to fewer than 70 companies.
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