Transit Operator Health and Wellness Programs (2004)

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29 CHAPTER FOUR CASE STUDIES This chapter provides case studies of six transit agencies that have successfully implemented operator health and wellness programs. In developing the case studies, telephone interviews were conducted with wellness program managers and other appropriate staff at four agencies. In two instances—Utah Transit Authority and Regional Transportation District— data collection occurred during on-site visits to the agen- cies. In each case, the agency’s survey responses was the starting point for gathering additional data on the organiza- tion’s health and wellness program practices and experi- ences. In the case of telephone interviews, data were re- corded through audiotapes and note taking, which was then analyzed and summarized into appropriate categories. Dur- ing site visits, data collection was conducted through note taking and observations. A brief overview of the mix of case study agencies follows. Pierce Transit, Lakewood, Washington—a 15-year pro- gram in a medium-sized agency, largely self-supporting through employee fund-raisers. The program is an example of how employee empowerment can be converted into sus- tained commitment and action. MetroLINK, Rock Island, Illinois—a 2-year program in a 57-bus operator agency that has strong labor–management support and an active health and wellness committee. Central Florida Transportation Authority, Orlando, Flor- ida—a 5-year program with participation that has increased substantially in the past 2 years; strong coordination with other programs such as EAP, drug and alcohol testing, workers’ compensation, benefits, and orientation and train- ing for new operators. Utah Transit Authority, Salt Lake City, Utah—a 19-year comprehensive health and wellness program with strong la- bor–management support. The agency allows spouses to par- ticipate in all program activities offered to employees. Operat- ing in a supportive organizational environment; the program is coordinated with safety, EAP, benefits, orientation and train- ing for new operators, and workers’ compensation programs. Orange County Transportation Authority, Orange, Cali- fornia—a 12-year program with strong survey responses regarding integration of health and wellness into other or- ganizational activities, and operating and communication plans, as well as into the organizational environment. Regional Transportation District, Denver, Colorado—a 14-year comprehensive health and wellness program that includes an on-the-job-injury rehabilitation clinic located in the wellness center. PIERCE TRANSIT Background Pierce Transit (PT), located in Tacoma Washington, is the state’s second largest public transit agency. Serving a 450 mi2 urban and rural area of Pierce County, it has a staff of approximately 835 employees, including 474 bus opera- tors. Because of its concern for the health and well-being of its employees, the agency has sponsored a health and wellness program for at least 15 years to address a number of health risk factors. Primary among these for bus opera- tors are the lack of physical activity, unhealthful diet, and smoking. The health and wellness program activities at PT are part of a corporate strategy of high involvement by employees. Employees from a number of departments, in- cluding bus operators, work collaboratively to make health and wellness an organizational priority with the support of a management team that fosters a culture of inclusion. The agency’s Strategic Business Plan for 2004–2009 demon- strates a continued commitment to employee involvement and the health and well-being of its employees. Under the plan’s Objective 5: “Maintain a dedicated and professional workforce,” two strategies key to the operation of the wellness program are outlined: • Involve employees in decision making. • Promote employee wellness and a balance between work and other life activities. Health and wellness activities at PT focus primarily on creating and maintaining awareness of healthful lifestyles (60%), educating employees about specific health and wellness issues (20%), and behavior change support (20%). An estimated 20% to 25% of bus operators partici- pate in program activities. Management Support For the past 11 years, PT has assigned responsibility for leading its health and wellness program, Health Express, to the same employee relations coordinator. The program co-

30 ordinator annually spends approximately 20% of her time managing the program. In addition, PT’s leadership team supports the involvement of a wellness advisory committee to help plan and staff program activities. A contingent of six bus operators is part of the committee. In the past, advi- sory committee membership has been based primarily on employees expressing an interest. In 2003, because mem- bership had declined, the coordinator posted a recruitment notice for members. So many operators expressed interest that interviews were conducted to select three new operator members. In addition to the six operators, the committee is composed of three maintenance employees, one customer service employee, one parts room employee, one adminis- trative employee, and the program coordinator. Funding for program activities is split among alloca- tions made by the agency, $4,000 annually; commissions received from vending machines in employee lounges; and $2,000 earned through employee fund-raisers, events that emphasize healthy lifestyles. For instance, the Summer Salad Sale was announced on a flyer that stated, in part, “Bring a salad to share and eat free. Come away with some new recipes.” Agency funds are used to pay 50% of the costs of a number of program activities: flu and pneumonia shots, incentives for the walking program, and screening tests at health fairs. In addition, the agency sponsors the atten- dance by all operations department field supervisors at the two-day Critical Incident Stress Management training, which allows these individuals to support PT’s Critical In- cident Peer Support Team. The team is an employee crisis assistance group that is separate from, but complementary to, the wellness advisory committee. Union Support In addition to having operators serve on the advisory committee, ATU leadership actively supports the program. The union pays registration fees for its members who par- ticipate in the Relay for Life, an annual team run/walk event sponsored nationally by the American Cancer Soci- ety. The union also sends members of its executive com- mittee to the 2-day training that the agency’s Critical Inci- dent Peer Support Team completes. Health Express Program Management As mentioned, overall program coordination is the respon- sibility of the employee relations coordinator. Other em- ployees spend varying amounts of time on advisory com- mittee activities; some being release time and other being voluntary, on their own time. Four to six times a year, the program coordinator provides the Operations Department dispatch office with a list of operators needed to staff pro- gram activities, receiving consistently excellent coopera- tion. In some cases, an operator may be released for as much as 1 full day or as little as 2 h. In either case, his or her run is filled by another operator. The following information is provided to PT employees about the role of the Health Express advisory committee: You will find the Mission Statement and Goals developed by your committee to guide us in our planning on the reverse side of this document. In carrying out these goals, your committee sponsors a diversity of programs and activities. Annually we have held a spring and fall health fair focus- ing on a variety of health and wellness issues. At these fairs we have provided not only information but also opportunities for health screenings such as blood pressure, cholesterol, glu- cose, body fat, and health risk assessments. For several years we have sponsored the Walking Club from May 1 through Halloween that provides incentives for completing certain walking, running, or biking goals. We maintain the fitness fa- cilities in the Administration and Maintenance Buildings and are responsible for the 0.6 mile track and exercise stations around the bus parking lot. We coordinate the annual flu shot program and volunteer to prepare and serve breakfast or lunch for the Agency’s annual roadeo. In addition, we support team participation in the annual American Cancer Society Relay for Life held at Stadium Bowl and the American Heart Associa- tion Heart Walk held in the fall. Because we are essentially self-supporting, we conduct a number of fundraisers throughout the year to raise money for the purchase of exercise equipment, incentives, and snacks and supplies for promotional events. Also annually we have put on the Holiday Stress Break as a way of thanking employ- ees for your support. The fund raisers serve a dual purpose by also promoting healthy lifestyle choices: the Salmon/Chicken Barbecue is a very low-fat meal, the Summer Salad Sale pro- motes adding more vegetables to our diets, the soup sales en- courage considering fast food alternatives for lunch, the raffles generally have wellness related prizes. Pierce Transit supports this program by providing time for employees to serve on the committee, space for exercise facili- ties and wellness events, assisting with the cost of incentives, subsidizing the flu shots, and purchasing books and newslet- ters for the wellness library located in Human Resources. Health Express Program MISSION STATEMENT The mission of the Health Express program is to provide opportunities to the employees of Pierce Transit to learn about ways in which they can take control of their own health and well-being and to encourage them to incorpo- rate this information into their daily lifestyle choices. The Health Express program has five goals: • To provide information to PT employees regarding lifestyle choices that affect health and well-being. • To provide opportunities for employees to evaluate their current health status through periodic screen- ings and risk assessment tools.

31 • To provide facilities equipped to enable employees to incorporate aerobic and other exercise into their daily lives. • To encourage employees to take charge of their health and well-being through the use of incentives and rewards for healthful behavior. • To foster an atmosphere of acceptance that en- courages participation in lifestyle changes at what- ever level the employee chooses. Activities Specifically Related to Primary Risk Factors: Physical Fitness Through the following PT newsletter article, employees learned about a Health Express physical fitness initiative: GET ON BOARD THE HEALTH EXPRESS The one constant in health living advice is—EXERCISE, EXERCISE, EXERCISE. To maintain a healthy heart, to prevent cancer, to stave off osteoporosis—exercise is the key ingredient. Your Health Express Committee en- courages you to join in its annual exercise program by committing to walking, running, or biking between May Day (May 1) and Halloween (October 31). Not only will you reap the benefits associated with regular exercise but you will also earn incentives as you go. See the posters for miles needed for each incentive. It’s a very flexible program. You can do this here at work, at home, or at a gym. The track around the bus lot is 0.6 of a mile long. Time on the elliptical or stair climber machines in the fitness penthouse can be expressed in miles too. Get your exercise calendars from HR and start recording your miles. Begin now to invest in yourself and be a healthier you. The program consisted of five milestones at which in- centives could be earned. To qualify for incentives, em- ployees logged mileage on a calendar log provided by HR, which they turned in at the end of each month, at which time they received the incentive they earned. Program in- centives ranged from a hat for walking 25 mi, or running or biking 100 mi, to a sports bag for walking 300 mi, run- ning 500 mi, or biking 600 mi. Other incentives included hand weights and a short-sleeved golf shirt for mileage goals reached between these limits. Employees who walked at least 25 mi, or ran or biked 50 mi, were eligible for a certificate recognizing their participation. Mileage could be gained through walking or running on a treadmill, as well as by riding a stationary bike. Another way that PT encourages physical activities among the staff is to provide 12 bike lockers for employees who ride bikes to work. Weight Management Health Express has approached the risk of unhealthful diets through a number of activities. On one occasion, the pro- gram retained the services of a dietitian who provided group education on nutrition and weight management strategies. The 2003 fall health fair had diet and nutrition as its primary focus, a theme that took advantage of the current national interest in obesity and its impact on health. The program has also offered the 16-week Weight Watch- ers at Work program, for which PT provided space and employees paid the fee for participation. Smoking Cessation The third primary health risk factor for operators identified by the PT health and wellness program coordinator was smoking. One approach the agency uses to assist in reduc- ing the prevalence of this risk factor is a smoking cessation reimbursement program. In a bulletin about the program, its purpose is explained. When an employee quits smoking, both the employee and em- ployer gain substantial benefit. The employee who stops smoking will feel better, live a longer, healthier life, be proud of the accomplishment, and gain financial savings. The em- ployer will see increased productivity, decreased absenteeism, and decreased health care expenses. In the hope that everyone will benefit, Pierce Transit has adopted a Smoking Cessation Reimbursement Program for all employees. Through this pro- gram, an employee may be reimbursed 50% of the cost of smoking cessation class, prescription program, or other alter- native methods to a maximum of $75, after three (3) months of non-smoking. Participation is voluntary. A listing of smoking cessation programs in Pierce County is available in Human Resources. Periodic in- house smoking cessation programs will be offered at minimal cost to the employee. Sign-up sheets will be posted on Agency bulletin boards. Program Guidelines • Prior to the start of the class, prescription program, or alternative method, a smoking cessation reim- bursement request form must be completed by the employee and submitted to the VP, Human Re- sources & Labor Relations, or designee for ap- proval and to ensure that the request complies with these guidelines. • The smoking cessation course, prescription pro- gram, or alternative method for which reimburse- ment is requested will be verified by the Human Resources Department. • The smoking cessation course must be taken on the employee’s own time. • Reimbursement will be limited to 50% of the cost of the course, prescriptions, or alternative methods up to a maximum of $75, to be paid after three (3) months of non-smoking. • To be eligible for reimbursement, the employee must complete the approved program and present proof of payment. Reimbursement will be paid no earlier than three (3) months, following successful smoking cessation.

32 • Employees may receive reimbursement for a maxi- mum of two (2) smoking cessation programs during their employment with Pierce Transit. On-Site Fitness Resources The primary fitness center at PT, a space of approximately 15 ft × 16 ft, is located on the roof of the agency’s admini- stration building. The facility, known as the Fitness Pent- house, contains a mirrored wall, padded flooring, chin-up bar, slant board (for sit-ups), Stairmaster, elliptical cross- training machine, cross-country skiing machine, and a bi- cycle, as well as a television/videocassette recorder and ra- dio/audiotape player. Most Fitness Penthouse equipment was purchased with funds raised by advisory committee activities. Operators also have access to a fitness facility in the maintenance building, which is equipped with a ping- pong table, weight machine, and rowing machine. Integration of Health and Wellness with Other Quality of Work Life Programs Operator health and wellness activities at PT are coordi- nated with a number of other programs that affect operator well-being. Operators serve on the Safety Committee and therefore have a voice in matters affecting their ability to perform their jobs. Their input is sought on issues related to bus stops, seats, and mirrors. The Health Express coor- dinator serves in an ex-officio capacity on the committee and reports that comments and suggestions made by opera- tor members are forwarded to the manager responsible for addressing the issue. Another employee-driven program of vital importance to the health and well-being of PT operators is the Critical Incident Peer Support Team. This group, a team of em- ployees trained in workplace crisis management, is avail- able by pager 24 h a day to help fellow employees cope with stressful situations. Team members refer employees requiring additional post-crisis support to the contracted EAP provider. An elder care contract that the wellness coordinator manages, separate from the Health Express program, pro- vides information about resources available nationwide to employees with elderly family members. The transit agency pays for the first telephone contact with the elder care resource provider, which has a database of resources available nationwide. During the first call, employees are asked a series of questions to help steer them in the direc- tion of resources likely to meet their needs. If the employee needs subsequent contact with the provider, he or she pays for those calls. Similar resources are provided through a contract with a local child care resource provider. The operations department training staff includes informa- tion about Health Express orientation and training for new op- erators. During orientation new operators tour the administra- tion building, including the Fitness Penthouse. Another program related to wellness, but separate from the activities of the wellness advisory committee, is PT’s JUMP Team. Several years ago, PT purchased two auto- matic external defibrillators (AED), in recognition of the importance of minimizing the time between sudden cardiac arrest and access to defibrillation. One AED is located in the operations dispatch office, and the other in the mainte- nance supervisor’s area. A group of employees, known as the JUMP Team, has been trained to respond to medical emergencies where external defibrillation may be required. The machines are compatible with those used by the local emergency responders, so that the pads can be unplugged from PT’s equipment and attached to that of emergency personnel. In addition, two employees have qualified as trainers and have incorporated training on the AEDs in their first aid/cardiopulmonary resuscitation classes. The agency has developed an emergency response protocol that is posted at the reception desk, dispatch area, and mainte- nance supervisor’s area. PT has a program that allows employees to make sug- gestions for improving their work life and productivity at the agency. Suggestions resulting in cost savings can net the employee an award of $25 to $500. The operations department publishes a newsletter each payday. That publi- cation is one mechanism used to provide ongoing informa- tion about health and wellness issues and programs. Integration with External Resources PT makes use of a variety of community occupational health resources to achieve its health and wellness goals. One such event is twice-a-year employee health fair. Dur- ing the spring 2003 health fair, Multicare HealthWorks, a local occupational health services firm, conducted total cholesterol and blood pressure screenings. The cost of the screenings was $10 per employee, with one-half of the cost paid by the agency and one-half by the employee. Employ- ees who had not had tetanus shots in the previous 10 years could receive them at the health fair at a cost of $15, shared equally by the agency and the employee. Informa- tion displays were available on breast, prostate, and other cancers. In addition, the PT Critical Incident Peer Support Team staffed a table and provided information about that employee resource. Employee participation in community events, such as the Relay for Life sponsored by the American Cancer So- ciety and the Heart Walk sponsored by the American Heart Association, has been quite high. In 2003, through a vari-

33 ety of fund-raisers, employees raised more than $7,000 for Relay for Life and more than $12,000 for the Heart Walk. The following is a representative calendar of the pro- gram’s wide variety of projects. 2003 HEALTH EXPRESS Activities Calendar January Planning “Retreat” to set calendar of ac- tivities for the year. Identified captains for participation in Cancer Relay for Life event in May. February Developed plans for Spring Health Fair. March Conducted process for adding members to committee—selected 4 additional operators out of 16 who expressed an interest; added one administration and two maintenance representatives. Health Fair & Soup Sale—provided for cholesterol and blood pressure checks (cost shared 50/50 employee and PT). 1st Quarter Blood Drive. April Fund-raisers for Cancer Relay for Life Team. Department basket raffle, car wash, cookie sales, ice cream sundaes sale, 50/50 raffle; raised over $7000. Annual Walking Club Start Date—April 1 (runs through Halloween). May Tacoma American Cancer Society Relay for Life—about 15 employees and fam- ily members participated; 3 employee survivors (participated in survivors’ lap). Volunteered to coordinate annual Bus Roadeo Luncheon; ensured lower fat options available. June Planned Summer Activities. 2nd Quarter Blood Drive. July Summer Salad Sale—Salad bar and salad potluck (donations). August 13th Annual Salmon/Chicken Barbecue— low-fat meal served under tent in bus parking lot: choice of barbecued salmon or chicken breast, calico beans, rice, fruit, roll, and lemonade. September Planning for Fall Health Fair. 3rd Quarter Blood Drive. October Fall Health Fair & Soup Sale—Emphasis on healthy diet; cholesterol, glucose and blood pressure checks; cost shared 50/50 agency/employee; seated mas- sage; registered dieticians; childhood diet info provided by child care resource provider; seniors and diet information provided by elder care resource pro- vider; EAP provider; information from American Diabetes Association and American Heart Association. November Annual Flu Shot Program—cost shared 50/50 agency/employee. December Holiday Stress Break—Serving hot cider, fruit, popcorn, and pretzels, and show relaxation videos in dimly lit board room; encouraging employees to take a few minutes to let go of the stresses asso- ciated with this busy time of the year. Program Challenges The current Human Resources Information System is not able to provide data needed to evaluate results on produc- tivity measures, such as comparing the absenteeism rates of employees who receive flu shots with those who have not. A new information system, currently in the planning stages, is expected to allow for better program data collec- tion and analysis. METROLINK Background The Rock Island County Metropolitan Mass Transit Dis- trict, known as MetroLINK, operates public transit services for eight Illinois municipalities: East Moline, Moline, Rock Island, Silvis, Milan, Carbon Cliff, Colona, and Hampton. The agency’s service area is referred to as the Quad City (East Moline and Rock Island, Illinois, and Bettendorf and Davenport, Iowa) area. Located in Rock Island, with a fleet of 57 accessible buses, four 15-passenger vans, two acces- sible vans, and two trolleys, MetroLINK has approxi- mately 120 employees, of which 82 are bus operators. On the synthesis survey, MetroLINK identified obesity, lack of physical activity, unhealthful diet, and stress as primary health risk factors for operators. Management Support After 5 years of seeing health care costs increase dramati- cally—by 35% in 2002—MetroLINK’s assistant director of finance, the employee benefits coordinator, spoke to employees about this issue at an annual all-staff training session in early 2002. She talked about a concept that she described as Wise Living, one in which employees could make lifestyle changes that might be helpful in reversing the trend of escalating health insurance premiums. To her surprise, 10 to 15 operators immediately expressed interest in being a part of this new initiative. As an initiative that “took off on its own momentum” after the initial discussion, the Wise Living program had no budget in its first year of operation (2002). In 2003, how- ever, $2,000 was allocated to cover the cost of incentives and supplies. The coordinator estimated that, on average, she spends approximately 10% to 15% of her time on health and wellness activities. She acknowledged spending a number of off-duty hours on program activities. Although she has no formal background in health and wellness, for years she has been the driving force behind MetroLINK’s observance of the Great American Smoke- out, the annual American Cancer Society’s program in

34 which volunteers and staff encourage employees to quit smoking for at least 1 day, in hopes that they will quit for- ever. Each year on this day, she has put on a giant cigarette costume and appeared at MetroLINK facilities. Therefore, her role as a health advocate was already well known within the agency. The employee benefits coordinator, the program coordinator for Wise Living, related that the gen- eral manager’s support of the program is 100%. He has served on one of the agency’s nine Active for Life teams and as part of the 10-week American Cancer Society workplace wellness program, which encourages employees to be more active on a regular basis by setting individual goals and forming teams for motivation and support. Union Support In addition to participation by bus operators, the past president of the ATU, Local 313, is an active member of the Wise Living committee. Program Features The agency has a 19-member wellness committee consist- ing of volunteers from the original all-staff training group and four administrative staff, including a representative from HR. Employees from Quad City Garage, the entity that maintains MetroLINK’s transit vehicles, also partici- pate in the Wise Living program. The committee meets monthly to educate itself on healthful lifestyle options and in alternate months sponsors health education for other MetroLINK employees. Notices of meetings and presenta- tions are included as payroll stuffers with employees’ pay- checks. Minutes of committee activities are prepared and disseminated to keep other employees informed of pro- gram activities. One of the wellness committee’s first efforts was a weight loss challenge in which employees set goals and took healthful actions to lose weight. Of the 52 partici- pants, 50% lost weight. Collectively, the group lost 500 lb, data that were documented in weekly weigh-ins at a Metro- LINK office. The weight loss effort was bolstered by twice-weekly training sessions conducted by the EAP pro- vider, which focused on body fat and weight loss strate- gies. At one session, the trainer brought in 5 lb of animal fat from a local grocer to dramatize that obesity is a sig- nificant health risk. The success of this weight loss effort was the beginning of a coordinated program that boasted the following first year accomplishments: • Joined as a group to promote Wise Living, • Completed a successful weight loss program, • Added fitness equipment, • Walked into second place in the Employee Fitness Walk (sponsored by John Deere Health and Quad City YMCAs), • Created a monthly newsletter, • Shared healthful foods and recipes, • Established fitness activities, • Promoted healthful initiatives, and • Gave free flu shots (an employee’s wife, a nurse, volunteered to give the shots). In 2003, program activities were expanded to include • Pneumonia shots ($25); • Stroke risk assessment for 44 employees: cholesterol screening, blood pressure check, and diabetes testing; • Wise Walkers—a 9-week competition with the CityLink (the Peoria, Illinois, transit agency) in which employees are provided free pedometers (72 issued on the first day of the competition) to measure their daily steps—with a goal of 10,000 steps per day; • Colon cancer presentations and screening kits made available to employees; • Blood drive in which employees contributed 15 pints of blood; • Safety fair that focused on home safety and health screenings (a renovated bus served as a command station); • Scheduled fruit days at facilities—apples, oranges, and bananas given away; • Summer softball games (three teams with 100% par- ticipation in one department); • Active Living—an extension of Wise Living that fo- cuses on regular activity (e.g., walking, yard work, swimming, running); • Maintain, Don’t Gain—a motivational program that runs from November 28 to January 3, designed to en- courage employees to stay fit over the winter holi- days; • Health and wellness books (employee-donated book rack); • Recognition cards for employees who commit to Ac- tive Living and other programs; • Employee-donated refrigerator and air popper for pop corn; and • Employee-donated stair climbing machine and exer- cise bikes. Communication Ongoing communication about health and wellness activi- ties has been the key to the 2-year program’s success. The program’s Wise Living logo, designed by the agency’s ex- ecutive secretary, who also prepares the program’s monthly

35 newsletter, is featured on every communication about the program and its activities. Communications range from healthful recipes to weigh-in dates and times to the Wise Living program results (see Appendix C for examples). Employees who achieve goals are recognized and con- gratulated through colorfully illustrated Wise Living bulle- tins. A spiral-bound 2003 calendar featuring multicolored graphics, news about MetroLINK employees involved in healthful lifestyle activities, health and safety tips, recipes, and dates of national health awareness observances helps employees see themselves and coworkers making behavior changes. The wellness committee has developed an informational brochure that gives fellow employees the following infor- mation: Who We Are Wise Living was formed by a group of MetroLINK and Quad City Garage Employees who joined together in January 2002 to voluntarily promote the development of fitness through a program of health, nutrition, and exer- cise intended to assist employees (and their family members) in making changes that will reduce health risk and improve wellness. Our Mission Is To promote “Wise Living” by “Living Wise.” Our goal is to improve and enhance our lives and the lives of others. We encourage learning about and participating in wise choices in health, fitness, and nutrition. Our Motto Is “Living Wise Enhances Lives” What We Do Promote a healthier lifestyle through the workplace Where We’re Going • We’re traveling the road to a healthier lifestyle. • We’re picking up speed on health and fitness. • We’re gearing towards wiser living through per- sonal choice, education, and family participation. • We’re promoting family involvement: Setting goals to fit your lifestyle. • We’re working towards camaraderie and teamwork. • We’re seeking a healthy balance of health and hap- piness. Coordination with External Groups The program coordinator, as “Lifestyle Wellness Warrior” and MetroLINK representative in the Quad Cities Health Initiative—a community partnership of more than 300 community members focusing on improving physical, mental, economic, social, and environmental health in the Quad City region—is able to make a number of commu- nity resources available to the agency and its employees. Projects that the group has sponsored or is affiliated with include Dental Care Smiles for All Team, Lifestyle Well- ness Warriors, Heat Emergency Task Force, Kids Health- net, Tobacco-Free QC, and the Quad Cities Coalition on Adolescent Sexuality and Pregnancy. Program Evaluation From a qualitative perspective, the program coordinator described the experience of initiating the health and well- ness program at MetroLINK. Wise Living has been the highlight of my 20-year career at MetroLINK. It has been a rebirth of my desire to help our em- ployees achieve a healthy lifestyle. I can truly say that chairing this committee is a true joy for me. The enthusiasm and ideas that flow from this committee are fantastic. One of the most important accomplishments our group has achieved is the ca- maraderie that has excelled from this committee. Data from individual program activities indicate that the program is experiencing success in increasing employee enthusiasm for maintaining healthful lifestyles. Much of the feedback about the program’s impact is anecdotal: “I don’t have to take my medication anymore. I couldn’t do it without the program;” or “I bought exercise equipment for my home and my wife and children use it too.” With the impetus for the program being ways to slow down or re- verse the rising health care costs, analysis of data in this area will be important as the program matures. CENTRAL FLORIDA REGIONAL TRANSPORTATION AUTHORITY Background The Central Florida Regional Transportation Authority, do- ing business as LYNX since 1992, provides regularly scheduled bus service to Orange, Seminole, and Osceola counties with a staff of 908 employees; 544 (60%) are bus operators. Eighty-two percent of the bus operators are male. Primary risk factors for operators at LYNX are re- ported to be obesity, hypertension, stress, smoking, lack of physical activity, and unhealthful diets. Management Support The wellness program at LYNX, located in the HR de- partment, was started approximately 8 years ago at the re- quest of bargaining unit employees (represented by the ATU), who wanted an exercise facility at work. Initially, part-time employees, with high turnover rates, staffed the program. Six years ago the agency hired a wellness profes- sional with a master’s degree in exercise physiology. His expertise in corporate wellness programming has brought the agency a level of knowledge, skill, and stability that

36 has allowed it to design and operate a program that is much used by LYNX employees. The program coordinator, under the supervision of the LYNX employee relations coordina- tor, plans program activities as part of the HR planning and budgeting process. In response to employee requests, the agency converted a former loading dock at one of the bus operating facilities, a 30- by 40-ft space, into the current wellness center. Equipped with a treadmill, modular train- ing equipment, elliptical trainer, Stairmaster, weight resis- tance equipment, free weights, a videotape player, and aerobic training videotapes, the center is the focal point of LYNX health and wellness activities. Union Support “The union president works out here each morning,” was the response to a question about whether the union sup- ports the wellness program. The program coordinator also reported that the union official, a bus operator, encourages other operators to follow his lead in developing and main- taining a consistent exercise regimen. Health and Wellness Program Activities Activities that create awareness about healthful lifestyles constitute one-third of the program effort, those designed to educate employees about ways to address specific health and wellness issues make up another one-third, and spe- cific behavior (lifestyle) change strategies constitute the fi- nal one-third of the effort. Table 6 summarizes the types of activities available at LYNX. Employees interested in using the wellness center must first complete a physical activity readiness questionnaire, health history questionnaire, consent/release form, fitness test, and equipment orientation. Employees with certain medical conditions or health risk factors must secure permission from their physicians before exercising in the LYNX facility. Open Monday through Friday from 7:00 a.m. to 5:00 p.m., the wellness center offers the following services: • Wellness counseling—Counselors offer information and advice about exercise performance and routines, nutrition, and other health issues. A broad range of wellness brochures and posters are displayed. • Fitness testing—In addition to undergoing an initial screening, employees can also receive body fat, height, weight, blood pressure, girth, flexibility, mus- cle endurance, and target heart rate measurements. • Heart rate monitors—Employees can use these free during workouts to keep track of heart beats per min- ute and compare the readings to their target heart rate. • Fitness training—This is conducted by a certified fit- ness trainer who sets up exercise plans and individu- ally coaches employees during workouts. • Blood pressure monitoring—Confidential blood pres- sure checks are available at any time. • Body fat measurement and weight loss advising— Employees desiring to lose weight can come in for body fat measurement and receive advice on natural and practical steps toward health and permanent weight loss. • Showers and lockers—Employees desiring locker space provide their own locks for use only during the workout period. The center has one shower for male employees and one for female employees. In addi- tion, bike storage facilities are available. The LYNX staff records employee wellness center utili- zation data by two categories: bargaining unit and admin- istrative. Bus operators make up the largest occupational group of bargaining unit employees. The wellness coordi- nator reported that although exact statistics are not avail- able, operators far exceed other employees in the use of the wellness center. A recent survey of bargaining unit em- ployees revealed the following about why they use the wellness center: • Annual physicals (preparation), 30%; • Weight loss, 25%; • To reduce blood pressure, 20%; • To reduce stress, 15%; TABLE 6 SUMMARY OF LY X WELLNESS ACTIVITIES N Activities Health Information (awareness) Group Education Individual Counseling Physical activity X X Smoking cessation X X Nutrition X X Weight management X X Cardiovascular disease prevention X Responsible alcohol use X Stress management X Disease management X X Flu shots X

37 • To maintain physical fitness, 5%; and • Other, 5%. Data for the past several years show that use of wellness program activities has increased annually. • In 2000—305 employees used the facility; 259 bar- gaining-unit employees; • In 2001—320 employees used the facility; 272 bargain- ing unit employees; • In 2002—380 employees used the facility; 330 bargain- ing unit employees; and • In 2003 through October 31, 2003—378 employees used the facility; 332 bargaining unit employees. Health Fairs Twice-a-year health fairs are conducted at the agency’s two bus operating facilities. The wellness staff invite a broad range of free community resources to give employees as comprehensive an exposure to health and wellness infor- mation and screenings as possible. Two health fairs were conducted, one in 2001 and one in 2002: total participation in 2001 was 255 and in 2002 was 368, for a 44% increase in annual participation. A sampling of health fair activities and community resources includes the following: • Health screenings—hearing, glucose and cholesterol, blood pressure, vision, and lower back strength; • Information booths—HIV/AIDS prevention, proper and safe handling of food, and child care resources; • Health insurance plan providers; • EAP; • Acupuncture and alternative medicine providers; – Public and nonprofit agency representatives, – Orange County Parks and Recreation Department, – Orange County Health Department, – Epilepsy Association of Central Florida, and – Preventive Blindness of Florida. Program Evaluation Other than utilization data that show increases in the use of the wellness center annually over the past 4 years, there is an evaluation of program activities that has been indi- vidual and anecdotal in nature. For instance, employees request evaluations of progress toward wellness goals, such as weekly body fat measurements. The coordinator reported instances in which employees report that they have been off antihypertensive medications as a result of exercising and participating in wellness program activi- ties. He estimated that approximately 75% to 80% of bus operators who start a wellness program continue it long term. Program Challenges Because of staff cuts in 2003, a part-time staff member as- signed to the wellness program was terminated, leaving the wellness coordinator with the responsibility to maintain the program as outlined above. Also, space constraints limit the amount of health and wellness activity that can be made available to employees at one time. A new wellness center, planned for the new LYNX building that is under construction, will have approximately twice the space as that of the current facility. ORANGE COUNTY TRANSPORTATION AUTHORITY Background Formed in 1991 by the consolidation of seven California transportation agencies, the Orange County Transportation Authority’s (OCTA) mission is to create, coordinate, fi- nance, and deliver an easy-to-use transportation network to keep Orange County moving and meet the public’s needs. Headquartered in Orange, California, the agency has a staff of approximately 2,000. The approximately 1,200 bus op- erators make up 58% of the work force. The operator work force is 71% male, with 66% of the operators more than 40 years old. In response to the synthesis survey, the agency identified primary health risk factors among the operators as lack of physical activity, unhealthful diet, obesity, un- controlled hypertension, uncontrolled Type 2 diabetes, er- gonomics and back health, and stress. Management Support The OCTA health and wellness program was started in 1991. Located in the Human Resources and Risk Manage- ment Division, the program operates with a budget of $220,500. The current administrator, who has a master’s degree in exercise science and 12 years in workplace well- ness, has managed a health and wellness program for the past 5 years that emphasizes awareness activities (70%), education (20%), and behavior change (10%). An ap- pointed wellness committee, which includes six coach op- erators, helps to plan and serve as advocates of program activities. Committee members are appointed by their managers and must be dynamic supporters of the program to be considered for this assignment. Managers at OCTA actively promote participation in health and wellness activities, such as the Learn While Lunching health education series and stretching classes, by encouraging operators to participate and by attending sessions themselves. Some managers give employees gift certificates for participating in stretching and walking classes.

38 The Wellness Program Employee Needs Assessment Survey In an effort to design and maintain a wellness program that is relevant to employees, the wellness program conducts sur- veys to get input about health needs and interests. The intro- duction to the “OCTA Wellness: Employee Needs Assessment Survey,” which is distributed agency-wide, states that: Your help is needed in planning our health promotion pro- gram. We need to be sure the program meets the needs of all of the employees and the expectations of management. This is just one step in our ongoing evaluation of the Wellness pro- gram. We want to provide you with information you need and the program’s implementation and outcomes. The survey includes a potential list of program topics for which employees are asked to state their preferences. Also included are lists of preferred presentation techniques and lengths for education activities, best times of day for activities, health screening in which employees would have an interest, activities in which they would most likely partici- pate, whether they would be willing to share costs for some programs, and types of incentives that would prompt them to make healthful behavior changes. Surveys distributed to su- pervisors and managers also ask them to list OCTA strengths that would help make the wellness program successful, as well as challenges that should be considered in implement- ing the wellness program (see Appendix C). Annual Operating Plan The 13-page OCTA 2003 annual operating plan outlined the overall focus of the program, its goals, objectives, and activities. Program goals were to • Assist employees and their families in making life- style changes to reduce health risks; • Enhance employees’ well-being and productivity through reduction in workers’ compensation claims and expenses; • Develop new and innovative strategies to reach the groups and individuals through education and infor- mation; and • Establish a leadership role for the wellness program among the company leaders, academic institutions, and other public and professional organizations. (See Appendix C for the full 2003 operating plan.) Health Screenings Employees have access to a number of health screenings through the wellness program, which can help them iden- tify risk factors for degenerative diseases, behaviors, and current physiologic measurements that may require physi- cian referral. Screenings include • Chart Your Progress: measurements of height and weight as part of weight loss and exercise programs; • Resting heart rate and blood pressure; • Low back health screen; • Cholesterol screening; and • High-risk audiometric testing, performed by a spe- cialist from the safety department. Education Programs Learn While Lunching Group Education Group health education sessions are an integral part of the OCTA program. As shown in Table 7, attendance at Learn While Lunching av- eraged 14 to 19 employees per session between 1999 and 2002. The program administrator explains that a number of factors appear to determine employee interest in a given topic, including redundancy from previous presentations on the same topic, and cancellations and rescheduling of sessions. Learn While Lunching sessions cover a variety of topics, ranging from those that focus on specific diseases to those on complementary health practices. TABLE 7 S UMMARY OF OCTA LEARN WHILE LUNCHING ACTIVITY Year No. of Presentations Total Attendance Average per Session 2002 14 192 14 2001 13 325 19 2000 18 342 17 1999 17 291 17 Evaluations completed following the sessions held in 2002 showed that the highest-rated topics were aromather- apy, heart health, stress and anxiety, understanding aller- gies, skin health, and understanding diets. Back Education Classes The wellness program offers back education classes to coach operators designed to teach them the relationships between the spine, abdomen, hips, and lower extremities. Those classes also include in- formation on back exercises. An OCTA-produced video- tape shows operators the proper techniques for managing both acute and chronic low back problems while working within the bus. Wellness Library The wellness library is a repository of magazines, books, video- and audiotapes, brochures, and other wellness-related literature that employees can check out for a specified period of time. Wellness Information Centers The wellness informa- tion centers provide health information monthly in a locked

39 display case at each OCTA site. Monthly themes include in- formation from national health organizations such as the American Heart Association, American Cancer Society, and American Lung Association. The information centers also feature the Wellness Champion of the Quarter/Year, monthly wellness posters, and event announcements. On-Site Fitness Facilities Three on-site fitness facilities of approximately 850 ft2 each are managed by contract-certified fitness profession- als who staff each facility 3 to 4 h daily. These individuals must have a bachelor’s degree in exercise physiology and be certified by one of the national certifying bodies, such as the American Council on Exercise or the American Col- lege of Sports Medicine. Incentive-Based Programs Incentives designed to encourage employee participation and to recognize efforts toward behavior change are integrated into a number of OCTA’s health and wellness activities: • Shoes and Wheels Club—This is a program designed to promote cardiovascular fitness and improve over- all employee health. Using a point-reward system, the program requires employees to record their own activities—such as a physical activity, Learn While Lunching session, or annual bike ride—and submit log sheets to the wellness administrator each month. Employees earn Aerobucks, which can be exchanged for incentives that are included in a catalog of rewards. • Smoking Cessation Program—Employees can par- ticipate in an approved commercial program or one that is medically supervised and receive reimburse- ment of up to $500 upon completion of the program. • Weight Loss Program—Employees who participate in an approved nutritional or behavior-based program can receive a reimbursement of up to $500, with 50% of the reimbursement upon completion of the first half of the program. If weight loss, reduction in BMI, and waist-to-hip ratio are maintained after 6 months, the remainder of the reimbursement is paid. • Wellness Champion of the Quarter—Criteria for the selection as champion of the quarter are that the em- ployee makes a major lifestyle change—such as los- ing weight, implementing dietary changes, quitting smoking, and/or starting an exercise program; main- tains a healthful lifestyle, which includes regular ex- ercise and proper diet; motivates fellow employees through example or personal assistance; and partici- pates in any of the health and wellness programs of- fered. Employees selected as a champion for a quar- ter are eligible for consideration as the Wellness Champion of the Year. Annual Health Fair The annual health fair, held at each OCTA worksite, fea- tures a series of self-testing stations for employees who have not undergone formal wellness testing. In addition, stations featuring health and wellness vendors focus on topics such as exercise, cardiovascular disease, sports in- jury prevention, smoking and tobacco cessation, a healthful eating restaurant guide, nutrition and menu planning, weight control and eating disorders, cancer, and consumer awareness. Evaluation of each health fair occurs every 2 years. Employees are asked to select the vendors they found to be most valuable and to suggest vendors they would like to see at future health fairs. Incentives are given to employees who complete evaluation surveys. Coordination with Other OCTA Programs The wellness program has well-established linkages with other OCTA programs that focus on employee well-being. Ergonomic issues are addressed in collaboration with safety captains who are members of the safety committee. During the OCTA health fairs, these employees demon- strate procedures, such as the proper techniques for loading and unloading a wheelchair on a transit bus. The EAP, which is managed by the benefits division, is linked through activities such as Free & Clear, a commercially offered smoking cessation program, and Learn While Lunching presentations, such as managing holiday stress and how to choose a doctor. Benefits staff also participates in health fairs. Wellness and workers’ compensation staffs are linked, in part, because they are a part of the same divi- sion. Furthermore, the back education training program is of mutual interest and benefit to both functions. The transit operations department includes information about the wellness program during orientation and training classes for new operators. Employees receive brochures that de- scribe the specifics of different program activities, benefits to the employee, and how they can participate. Program Evaluation External Audit of Wellness Program, 2002 In 2002, the program administrator requested an external audit of the wellness program to evaluate the status of the program in a number of key areas: overall awareness, satis- faction, and integration of program activities. The audit, which included program documentation review, site visits to each wellness facility, and 20 interviews with coach op- erators, and maintenance and administrative staff—as well as benchmarking of wellness programs at four other public transportation organizations with similar employee popula- tions—produced a report of findings and recommenda-

40 tions. The consulting firm that conducted the audit focused on the following 10 areas: • Management commitment, • Program management, • Health assessment, • Programming, • Exercise opportunities, • Collaboration with other departments, • Data and evaluation, • Environmental support, • Program marketing, and • Integration. In 1999, the audit report pointed out that the OCTA pro- gram had earned the bronze level recognition in 1999 from the Wellness Councils of America (The Bronze Award rec- ognizes those companies that have obtained strong senior- level support, created integrated wellness teams, collected strategic organizational health data, and are delivering tailored programs to meet their company’s needs)— considered by many as North America’s premier resource for worksite wellness. The achievement recognizes em- ployers that have enlisted strong senior-level support, cre- ated integrated wellness teams, collected strategic organ- izational health data, and are delivering tailored programs to meet the need of their company. The report also noted that the OCTA program received the 2001 Business and Industry Award from the nonprofit professional organiza- tion, Association for Worksite Health Promotion. The audit summary identified five areas of program strength: management commitment to the program, enthu- siasm and responsiveness of the program administrator, di- versity and quality of wellness programs and health and fitness screenings offered, incentive and recognition pro- grams, and organization and planning. The summary iden- tified program challenges in three areas: the mobile work force, cultural factors—a generalized attitude toward exer- cise and nutrition having low priority—and the sedentary lifestyle of an aging work force. Among audit recommendations was one to move to a more results-oriented approach with clearly stated goals and measurable objectives, based on the needs assessment of the employee population. Accompanying this recom- mendation was a reference to the need for quantification and tracking of data to identify program impact. UTAH TRANSIT AUTHORITY Background The Utah Transit Authority (UTA) provides bus, light-rail, and paratransit services to municipalities in the Wasatch Front area of Utah. UTA has 1,700 employees; 750 are bus operators and 80 are light-rail operators. Eighty-one per- cent of operators are male. Synthesis survey data revealed that UTA operators have a number of primary health con- cerns including • Obesity, • Lack of physical activity, • High cholesterol, • Uncontrolled diabetes, and • Uncontrolled hypertension. Management and Union Support: Partnership in Wellness The wellness program, located within the HR department, has been in operation since 1984, with an equal amount of focus on creating awareness of healthful lifestyles, educat- ing employees and their families about specific health is- sues and approaches for addressing them, and supporting healthful behavior changes. Operating on a budget of $200,000 (excluding salaries), the program has seen par- ticipation increase substantially over the past 2 years. Throughout the program’s existence, senior management has supported it through a variety of means, including for- mal written documents and public addresses and by pro- viding adequate resources of budget, space, and staff to operate the program. Each department director contributes funds ($7.00 per employee) to the wellness program each month. Managers also actively promote participation in health and wellness activities. Union support of the wellness program comes in a number of forms. For instance, union leadership has done the following: • Communicated the importance of the program to its membership, • Signed off on joint labor–management documents encouraging participation, and • Participated regularly in health and wellness activities. The joint labor–management partnership, evident in the support of the wellness program, reflects a culture of part- nership outlined in TCRP Report 77 (3). That report gave an account of how a strategic direction set by the UTA board of directors in 1997 has made partnering a way of doing business at the agency. A letter on the first page of the wellness program’s resource guide provides an exam- ple of how partnering is a core value at UTA. The letter from UTA’s chief performance officer, the local ATU president, and the wellness program administrator reads: Dear UTA Employee, At UTA we believe that an overall sense of well-being and a positive outlook are very important to physical and

41 mental health. Prevention of illness and/or injury is im- portant to you, your family, and our organization. We know that the challenging demands of daily life can be overwhelming and can make achieving better health a difficult task. Because we value you as an employee and person, we have developed programs and resources to help you and your family choose healthy alternatives. This booklet is designed to give you some insight into the different programs we offer in order to help you im- prove your physical and mental health. The UTA Well- ness Program promotes preventive measures as a way to achieve this goal. We invite you to take full advantage of the variety of wellness services we offer. Our qualified and motivated staff is available to you and ready to assist you in achieving your personal wellness goals. Make a com- mitment to good health today; it is the best health insur- ance you can get. Wellness Team Health and wellness activities at UTA are coordinated with a number of other agency programs: EAPs, workers’ com- pensation, employee benefits, orientation and training for new operators, ongoing training, staff meetings, division celebrations, and other activities. A joint labor–manage- ment insurance committee allows employee input into em- ployee health insurance plans. Operating Plan The annual operating plan for the wellness program speci- fies time lines for activities, incorporates marketing strate- gies for effective promotion of the program, and includes a plan for evaluating stated goals and objectives. To develop a program that is relevant to UTA employee needs, pro- gram staff collects data from a number of sources. • Health risk appraisals; • Health screenings—blood pressure, height, weight, and cholesterol; • Employee interest and needs survey; • Fitness-for-duty assessments; • Workplace facility assessment; • Work and family needs assessment; • Work schedule and shift assessment; • Health care claims and utilization; • EAP utilization; • Absenteeism; • Disability claims; • Workers’ compensation claims and costs; • Operator assault records; • Passenger-related incidents; • Passenger satisfaction survey reports; • Turnover records; • Union support; and • Organizational policy assessment. Communication Operators learn about program activities through program activity updates, information circulated by program staff concerning the availability of community resources, infor- mation provided about policy changes, and information sent to employees’ homes. Operators have opportunities by which to communicate feedback about program activities through formal communication channels such as sugges- tion boxes and interest surveys. The Wellness Program Throughout the year, the UTA provides numerous health and wellness services to employees and their spouses, sev- eral of which are listed here: • Take Care of Yourself book—this illustrated medical self-help book is given to each employee when hired. • Vitality magazine—this commercially prepared magazine that includes tips on how to stay healthy, nutritious recipes, and other health promotion infor- mation is distributed monthly to all divisions. • Healthy UTA Incentive Program—the Healthy UTA 2003 incentive brochure states that the program is designed to give employees and their spouses added incentives to improve and maintain good health and fitness habits. The program requires a free fitness evaluation upfront and is described as a . . . program that measures your present physical fitness and rewards you for your good health. You will receive $25.00 of each target area that you pass. If you pass all five target areas you will receive $250.00. The target areas are: Blood pressure, cholesterol, body fat percent, cardiovascular fitness and smoking status. The brochure goes on to state that all employees are eli- gible to participate in the program, as well as spouses of employees who are covered by UTA-paid insurance. As a means of encouraging employees who did not receive bonus money in 2002 because they failed to meet target area stan- dards, the program allows those individuals to qualify for a bonus for each target area in which they improve, to meet year-end goals. The brochure encourages employees who need accommodation to be able to participate to contact UTA’s Americans with Disability Act compliance officer. One strategy that has increased participation in Healthy UTA is mailing program information to employees’ homes. • Smoking cessation contract—Employees who remain smoke free for 1 year can earn a $100 bonus. At the

42 beginning of the year, employees submit a written application to enter the program. At the end of the year, to receive the bonus, the employee must pro- vide certification from a coworker that he or she has quit smoking for the required period. • Weight loss contract—Employees who reach their recommended weight and stay within 5% of that weight for 180 days earn a $100 bonus. Employees may also receive the cost of an approved weight con- trol program, up to $100 as well. Weight Watchers at Work is offered on-site at UTA at a cost of $121 per employee. • Fit Factories—A Fit Factory, a workout area, is lo- cated at each of UTA’s six facilities and is open to all employees and spouses. Although aerobic classes are offered at only one facility, employees can choose their own times to work out. Each Fit Factory is equipped with weight-training equipment, including free weights and weight machines, treadmill, stair-climbing ma- chine, stationary bicycle, and various fitness maga- zines. All but one facility also has a television/video- cassette recorder and cassette/radio system. • Personal exercise program—Employees desiring a personal exercise program can have one created to meet their individual needs by one of the professional wellness staff members at one of the fitness facilities. • Nutritional analysis and weight management— Qualified staff provides nutritional analysis and weight loss counseling to employees who want to improve the quality of their diet. Project “0” is one aspect of this program, in which employees weigh in during Thanksgiving week to determine their base- line weight. Employees who do not gain any weight during the holiday period, from Thanksgiving to New Year’s Day, receive awards. • Annual health fair—The UTA annual health fair pro- vides health screenings such as blood pressure, vi- sion, blood cholesterol, blood glucose levels, and prostate-specific antigen, as well as information in many other areas related to health promotion. Em- ployees found to have an elevated blood pressure are directed to see their own physicians. If those employ- ees have not reported back to the wellness staff about the referral outcome within 1 month, the blood pres- sure results are reported to management. • Injury rehabilitation—The wellness program pro- vides assistance to employees who need support with rehabilitation from work-related or personal injuries. • Resource library—The wellness program provides a lending library of exercise videotapes, recipe books, and motivational tapes. Employees can check out these materials on a short-term basis. • Sports program—UTA-sponsored sports tourna- ments, offered throughout the year, are an integral part of the wellness program. Employees participate in tournaments in the following sports: golf, ping- pong, volleyball, horseshoes, and mountain biking. Employees also participate in sports programs of- fered within the community. The agency sponsors memberships in county recreation sports teams and leagues by paying one-half of the registration fee and uniform cost for each employee. There are teams in five sports: basketball, softball, flag football, volley- ball, and bowling. • Health education—Throughout the year, the UTA of- fers employees health education classes. Most classes are free and include topics as varied as sleep disor- ders, depression, smoking cessation, and nutritional cooking. • Discount ticket sales—Employees can purchase tick- ets to various productions, special events, and vaca- tion attractions at discount prices at one UTA facility. Program Evaluation Evaluation of the Healthy UTA program outcomes is con- ducted annually, using data from the goals set and achieved by program participants. In 2001, a total of 891 employees participated in at least some part of the personal fitness program evaluation. Of these 325 were operators; 231 men and 94 women. Of the 891 employees, 234 had also par- ticipated in the 1997 evaluation, including 83 operators, al- lowing for some analysis of 5-year results. Evaluations fo- cused on targets set in the following areas: blood pressure, body fat, cholesterol, and smoking. The most relevant measurement of the effectiveness of the program consisted of the observed changes during the 5 years. The most sig- nificant program result was that more than one-half of par- ticipants at risk for tobacco use had quit smoking. REGIONAL TRANSPORTATION DISTRICT Background The Regional Transportation District (RTD) in Denver, Colorado, provides bus, light-rail, and paratransit services to a 2,410-mi2, seven-county service area of 38 municipali- ties. Established as a special district by the Colorado Gen- eral Assembly, RTD has approximately 2,400 employees, including 1,100 bus operators and 63 rail operators. Eighty-one percent of bus operators are male, whereas 91% of rail operators are male. Bus and rail operators at RTD experience a number of health risk factors common to operators at other transit agencies. • Lack of physical activity, • Unhealthful diet, • Stress, • Obesity, and • Uncontrolled hypertension.

43 Wellness and Rehabilitation Program The primary impetus for the health and wellness program at RTD—in operation since 1989—was a proposal made to the RTD board of directors in 1988 by the ATU local lead- ership. That proposal was to fund an annual physical and drug test for all employees, which local union membership referred to as a “wellness program.” Research of options for implementing the board-approved program resulted in the RTD senior management team’s proposing and receiv- ing approval for an alternative, cost-effective approach to improving employee health and well-being—a comprehen- sive health promotion program. The current program, grounded in the framework established in 1989, has some noticeable enhancements. Located within the HR division at RTD, with a 2003 budget of $382,239 (including salaries and benefits), the program has two complementary components: health pro- motion ($240,000) and on-the-job injury rehabilitation ($142,239). Staff for the program includes the program manager, who is a doctor of physical therapy; a regis- tered physical therapist, who works in occupational in- jury rehabilitation; and a wellness rehabilitation techni- cian, with a specialty in corporate wellness, and a health promotion specialist, both of whom work in the preven- tion and health promotion aspects of the program, known as Hooked on Health. Hooked on Health At RTD’s five locations, on-site wellness centers, equipped with a variety of exercise machines, showers, and lockers, provide a centralized location for health and wellness ac- tivities. Each location has a security system that allows 24- h access through the use of an assigned access code for each employee. Employees must submit a physician’s release and RTD waiver to be eligible to use the wellness centers. The well- ness staff is available by appointment to provide assistance to employees in reaching fitness goals. The centers provide services in the areas of nutrition; weight loss counseling; cholesterol, glucose, and blood pressure screening; body composition analysis; and general exercise prescription and rehabilitation. The program’s resource library is located at the Em- ployee Development Center, the agency’s largest wellness center, which also houses the rehabilitation program. This lending library of books, videotapes, audiocassettes, manu- als, and magazines provides information about health, be- havior, personal development, and professional develop- ment. Summary of Hooked on Health Services and Activities Hooked on Health offers a wide variety of features as fol- lows: • EAP—contracted no-cost counseling for all RTD employees and their families. • Employee recreational tournaments—softball, tennis, volleyball, and golf. • Blood drives—opportunity to donate blood at the work- site. Family members are permitted to participate. • Health fairs—each year, various health care providers and health agents provide screenings and health counseling to employees. Flu shots are also provided at no cost to employees. Family members are permit- ted to participate. • Blood pressure testing/monitoring on-site—follow- up education and counseling is available. • Preparation for department of transportation/com- mercial driver’s license physical—help with prob- lems related to retaining the license. • Blood lipid testing—cholesterol (high-density lipopro- tein and low-density lipoprotein), glucose, and triglyc- eride levels. Education and counseling is available. • Body composition analysis—percentage of body fat and hydration level measurements; individual cardio- vascular and/or strength-training programs. • Health education programs—healthy backs, stress management, Healthy Weighs (nutrition education program), nutrition and weight maintenance, and smoking cessation. • Bike program—bicycles and helmets are available at each RTD facility for employee checkout and use during breaks and lunch hour. • Post-occupational injury rehabilitation—individual programs designed to continue and/or reinforce pro- gress gained through RTD’s rehabilitation program. All Hooked on Health activities and events are an- nounced by way of posters and flyers posted at all RTD fa- cilities throughout the year and on the RTD intranet. Rehabilitation Program: Coordination with Legal Department Collaborative efforts between RTD’s Administration De- partment (HR Division) and Legal Department (Risk Man- agement Division) have resulted in a comprehensive strat- egy that has reduced workers’ compensation claims by nearly 50% over 3 years, representing a cost reduction of about $5.5 million. In 2000, a software upgrade to RTD’s information tech- nology allowed the agency to better capture reliable aggre- gate cost data on workers’ compensation. That year’s data

44 became the baseline for improvement and indicated an ag- gregate workers’ compensation cost of $7.7 million, with 538 claims. The per claim equivalent was $14,350. In 2002, RTD formulated a more focused, multifaceted plan to address the workers’ compensation challenge, as il- lustrated in Figure 10. A description of each phase of the coordinated strategy follows. Phase 1: Fee scheduling—Medical treatment and asso- ciated physical therapy is performed, by Colorado law, un- der predetermined rates by a process referred to as “fee scheduling.” Formerly, RTD paid a third-party administra- tor (TPA) to audit bills to ensure conformance with the fee schedule. Fees paid to the TPA were a percentage of the savings. An analysis of fee data determined that RTD would save further by in-sourcing the fee schedule audits. Without adding staff to risk management, the TPA function was brought in-house in February 2002. First year savings, February through December 2002, amounted to $687,000. In 2003, January through August, savings were $421,000. The former TPA would have discovered these same “sav- ings”; however, it would have charged a 20% fee for ser- vices or $228,000 for these two yearly amounts. It cost RTD $32,000 (database access fees to a third party) to re- cover these savings, for a net cost reduction of $196,000. Phase 2: In-house physical therapy—In February 2002, the RTD brought the physical therapy function in-house to better monitor and personalize prescribed treatment for workers’ compensation therapy. By filling two positions with existing vacancies, RTD performed this function without increasing budgeted head count and the atten- dant labor costs. In the inaugural year for physical ther- apy, 180 patients (245 cases) were treated, at a savings of $126,000. (Billing rates to determine the savings from the in-house physical therapy are extrapolated from the fee schedule; that is, what RTD would have otherwise been charged by the external therapists.) Fur- ther savings are derived by more effective accountabil- ity of employee time for scheduled treatments. Rehabili- tation visits can be verified, and employees receiving treatment while still permitted to work can return with less lost time. Phase 3: Pre-employment medical review—The RTD funded a series of human performance evaluations, by a clinical specialist, on three positions with the most recur- rent injuries, one of which was for a bus operator. This ac- tion was taken to develop a template for assessing an em- ployee’s ability to perform essential functions of the job. Such assessment, which follows the sequence of the fed- eral department of transportation pre-employment exami- nation, has been incorporated in the pre-employment (post- offer) process. Savings from this phase is conjectural, but it is expected that the agency is mitigating to some degree its future liability in workers’ compensation. This assessment is particularly designed to identify job candidates Phase II Coordinated Strategy Phase Implemented Phase Pre-Implementation Phase III Phase IV Phase V Phase I Physical Therapy Pre- employment MRO Wellness (aftercare) Injury Prevention W C $ W C $ W C $ FIGURE 10 RTD coordinated strategy for reducing workers’ compensation costs. WC = workers’ compensation; MRO = medical review office.

45 who may have pre-existing conditions which, unless thor- oughly reviewed, could have an impact on one’s ability to perform essential functions and potentially result in future workers’ compensation claims. Phase 4: Wellness and aftercare regimens—Data on a number of regimens targeted to the health and well-being of RTD employees, including rehabilitation aftercare, are reflected in Figure 11. Phase IV: 2002 Wellness - Aftercare Designed and implemented exercise regimens for WC aftercare - 40 Designed and implemented specific ailment/injury programs - 22 Maintained programs for general fitness - 69 Established programs for weight loss - 24 Bus Operator training - 63 EAP referrals - 23 In-house consultations - 18 FIGURE 11 RTD wellness and aftercare data. WC = workers’ compensation. Phase 5: Injury prevention program—This program augments the safety function with a specifically tailored regimen on preventing worker injury. It is a proactive awareness and training campaign for injury prevention. Although some measures in the combined strategy are directly quantifiable, such as the savings identified in physical therapy and fee scheduling, the combined benefits from the actions taken in each phase are positive. The per claim cost has been progressively reduced to the present level, representing a 46% reduction in workers’ compensation costs, although the overall RTD employee headcount has re- mained the same. Cost savings are illustrated in Figure 12. Other Program Coordination Hooked on Health staff work with a number of other RTD units to maximize the return on investment of agency re- sources. The safety division coordinates ergonomic and environmental health activities with the health promotion activities. Hooked on Health staff teaches a portion of the training for new operators and orients those employees to the various elements and benefits of the program, including requirements for gaining access to the wellness facilities and activities. Phase I: Workers’ Compensation Claims 538 $7,719 505 $5,578 393 $3,595 290 $2,259 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 2000 2001 2002 2003 Claims Cost $14,350 $11,045 $000 $9,150 $7,790*Per Claim *Per 8/31/03 FIGURE 12 RTD workers’ compensation claims cost data, 2000–2003.

46 Program Evaluation The evaluation of the rehabilitation component of the pro- gram as outlined is ongoing. Evaluation of Hooked on Health program aspects is not active at this time. Program Challenges Budget constraints resulted in the discontinuance of fund- ing of a comprehensive incentive program in 2002 that had been a core component of the Hooked on Health strategy since its inception. Incentives for participation in the pro- gram were outlined in the Champions of Transit program, which integrated employee health and wellness activities with employee community involvement. Featured as a best practice in TCRP Report 77 (3), the program was highlighted as an ef- fective means of bringing together two employee develop- ment and recognition activities as a strategic employee em- powerment approach. The same budgetary impacts have also reduced administrative support for the program, which has played a major role in the reduction of program utilization data collection and analysis.