The University of Michigan (U-M) is a higher education institution located in Ann Arbor, with additional campuses in Dearborn and Flint, and a large, complex health system. U-M employs about 48,000 faculty and staff, made up of approximately 62% women, 38% men, with an average age of 42 years old. All faculty and staff are eligible to participate in the university’s health and well-being programs. Some services are also available to retirees and benefit-eligible dependents.

The Workplace Mental Health and Wellness Initiative

The former president of U-M, Dr. Mary Sue Coleman, served on the board of Johnson & Johnson, where she learned about the comprehensive wellness program the company had implemented over many years. She decided to make health and well-being a presidential-level priority for U-M. She appointed a university-wide committee, chaired by the Dean of the School of Public Health, and consisting of a broad cross-section of faculty and administrative leaders with expertise or interest in health. LaVaughn Palma-Davis, an administrator in the health system with health promotion expertise, was asked to develop a strategic plan and provide programmatic leadership.

Early Emphasis on a Strong Strategic Plan

Palma-Davis began her strategic planning process by gathering data, resources and input from key sources, including the following:

1. U-M population data and information (internal claims data and an interest survey)

2. Best-practice information about other workplace wellness programs (HERO Scorecard, Leading by Example Survey, review of C. Everett Koop Award winners, and a benchmarking survey of peer organizations)

3. Key stakeholder and advisory committee input

4. Research reviews of evidence related to effective health and well-being programs

The information she gathered helped her perform a gap analysis for the university. She also learned how other large employers organized and budgeted for their health and well-being programs. The initial budget was based on best practice information that Palma-Davis gathered and on a per employee per year benefit fee structure.

Early on, Palma-Davis recognized the importance of involving university leaders and potential participants in meaningful ways. Numerous committees were formed to engage university representatives in various aspects of the program. For example, in addition to the university-wide advisory committee, other task groups were established to focus on recommendations related to physical activity, tobacco policy, mental health, ergonomics, healthy eating, communications and incentives. The teams began with small pilot programs between 2006-2008 and had visible quick wins in participation and interest.

Palma-Davis and her advisers developed a five-year strategic plan for MHealthy, the name of the program, along with the following vision and strategic goals:

Vision: The University of Michigan will be a model community of health where both the organization and the individual thrive.

Strategic Goals:

• Promote the health, well-being and quality of life of the U-M community by:

  • Keeping the well well

  • Helping those with health risks or chronic conditions improve their health

  • Fostering a healthy culture, environment and positive relationships that engage and support faculty, staff and the community at large

• Contribute to employee recruitment, retention and development through high quality health and well-being programs

• Contribute to the evidence on how effective health and well-being programs can improve lives

The university endorsed the five-year strategic plan and established an integrated organizational structure to carry it out, including existing and new resources in wellness and risk reduction programs, mental and emotional health counseling and occupational health services. Palma-Davis also added key resources in evaluation and marketing to the team. Reporting to the Associate Vice President for Human Resources, the comprehensive program officially launched in 2009 with university-wide wellness screenings, robust programs and services and a modest $100 incentive. Since then, MHealthy has seen great success with significant program participation and visible cultural and environmental changes throughout the university.

Emphasizing Mental and Emotional Health

The MHealthy philosophy of well-being included mental and emotional health from the program’s beginning, and representatives from U-M’s departments of psychiatry, psychology and social work are among the program’s advisers.

Measuring Impact

The program has had positive effects over a broad array of outcomes, including mental health and organizational performance. For example, health risk assessment participants classified as medium or high risk have decreased from 2009 to 2016, and participants classified as low risk have increased. Employee surveys show that the work culture and environment are viewed as supportive. And among users of EAP services, 88% said their work performance or productivity improved.

One health risk area, however, that did not change from 2009 to 2016 was depression. Data from health claims and health risk assessments showed that stress, depression, and anxiety are among the university’s top three health concerns, with high health care costs and prevalence associated with depression. Sources of self-reported stress were also analyzed, and “job responsibilities” and “coping with too much to do” were the top drivers. These data points created an impetus to target mental health and to make it a top priority in 2017 and 2018 for the communications and program enhancements described below. The health risk appraisal was not conducted in 2017 but was completed again in 2018.

 

 

Mental and Emotional Health Programs and Services

In addition to on-site employee assistance counseling services, MHealthy included large scale mental health awareness campaigns (e.g. Understanding U, National Depression Screening Day, National Mental Health Month, and Grief Awareness Week) and robust websites with online resources for addressing depression, anxiety, mental illness, sleep, and stress. It also offered targeted stress and alcohol management programs and critical incident debriefings.

To more accurately reflect the services provided and improve access, U-M renamed its two employee assistance programs (EAPs). They are now called: (1) Faculty and Staff Counseling and Consultation Office on the Ann Arbor campus and (2) the Office of Counseling and Workplace Resilience in the Michigan Medicine health system. Primary care providers in the health system are informed about the University’s counselors as a resource to provide care for employees considering shortages of mental health providers in the networks. In addition, the U-M Benefits Office worked with the psychiatry department to implement a coordinated care model to help primary care providers more effectively manage anxiety and depression in primary care settings.

U-M also created a new resiliency manager position to address mental health needs from a prevention, skill development and organizational perspective. This is particularly of interest to the university’s health system which has dedicated committees working on addressing the rising prevalence of clinician burnout including training and support for residents, physicians, and nurses, as well as leadership initiatives to address systemic stressors. Tailored programs for specific populations are also offered on trauma, secondary stress, grief, and compassion fatigue.

This year, the MHealthy team will be reaching out again to employees with a major communication campaign to de-stigmatize mental health and encourage help-seeking behavior. They will also be piloting mental health mobile programs on topics such as sleep, mindfulness, and depression management. In addition, Michigan Medicine is piloting the Institute for Health Improvement’s Finding and Creating Joy in Work framework.

Involving Leaders for Creating Healthy Cultures

Through leadership and culture change, the MHealthy program has developed and engaged nearly 700 health champions across the university, who volunteer their time and energy to organize and promote programs and events in the workplace. These champions receive special training and resources to raise awareness about health and well-being and help motivate co-workers to adopt healthy mindsets and behaviors. The MHealthy staff works with the champions’ supervisors to ensure that the champions are supported and honored for their contributions.

Involving leaders has been a strategic way of creating culture change around the value of well-being. The MHealthy team created a toolkit and training program to engage supervisors titled “Leaders Creating a Culture at its Best.” This four-hour training is provided free to managers to build capacity in their knowledge and skills related to employee health and well-being. Since launching in 2016, more than 600 managers have attended the trainings.

In addition, health and well-being behaviors are included in leadership competencies, and leaders receive annual reports showing department-specific program participation levels and risk factor information, with the top participating departments receiving recognition.

MHealthy has also created leadership videos used in leadership development programs and at events like the annual “Leadership Day” in the health system. The video, “Leaders Speak on Building Healthy Cultures,” features leaders from the health system and Ann Arbor campus to honor and acknowledge their involvement and influence. Each leader speaks to the importance of health and well-being to them and how the MHealthy program has helped them achieve meaningful milestones. Many leaders included how the program has contributed to their emotional well-being and sense of purpose at work.

Program Improvements

Program improvements are made regularly based on feedback from advisers and program participants through surveys, focus groups, and social media. All programs have process surveys that are monitored along with outcome data. Progress reports are provided to the Evaluation Committee. In addition, annual reviews of health risk and claims data are conducted to identify key issues. For example, an analysis completed by the Benefits Office found that higher wage workers are more likely to access mental health benefits and receive counseling than lower wage workers. The MHealthy and Benefits Office teams are digging deeper into potential barriers for lower wage workers (such as cost of co-pays, time off work, and transportation) and ways to address barriers to encourage access to care.

The MHealthy program has been nationally recognized with awards including the 2014 WELCOA Well Workplace Gold Award, the 2014 Edington Next Practice Award, the 2014-2016 Healthiest 100 Workplaces in America Award, and the 2017 Governor’s Healthy Workplace Award. Palma-Davis was honored with HERO’s 2017 Bill Whitmer Award for outstanding achievement of leaders in the health enhancement field.

Next Steps

MHealthy has now become part of the organizational fabric and is recognized as an important employee benefit, resource, and influencer of a positive university culture. The mental and emotional health priorities that the MHealthy leadership team will be focusing on in the next few years include:

• Addressing the needs of higher risk groups (such as lower wage workers) and individuals with chronic conditions (depression, back pain, diabetes and hypertension)

• Working with health care workers on resiliency and avoiding burnout

• Offering new mobile programs to improve the management of depression, anxiety and sleep disorders

Lessons Learned

The careful attention to strategic planning, program integration, and leader involvement throughout the U-M system has helped in the success of the MHealthy program, says Palma-Davis.

Here are recommendations for employers addressing mental health and creating workplace wellness programs:

• Set clear expectations for a long-term commitment and strategic plan

• Use a culture change management process by engaging key stakeholders in the planning process, creating a compelling case/vision, and developing visible champions for your program

• Recognize the value and importance of ongoing communication and program promotion

• Communicate a clear value proposition for the program (tie to business success)

• Integrate employee health and well-being into business objectives and practices

• Use data to identify key issues and measure progress

• Recognize that rewards and incentives can “get people on the bus,” but resources, culture, environment, and policies sustain behaviors and improvements

To learn more about the University of Michigan’s mental and emotional health initiatives and their wellness programs go to www.mhealthy.umich.edu.

The Center appreciates the contributions to this case study from LaVaughn Palma-Davis, Senior Director, Health & Well-Being Services.

Last updated: 5/31/18