Employee Wellness--and Beyond

Proactive efforts by the wellness program at Appleton Papers are a major benefit for employees as well as the company.

EMPLOYERS often struggle with the effects workplace injuries and illness have on employees, their families, and companies' financial health. These concerns have led many companies to explore options to prevent or more effectively manage workplace injuries and their associated costs.

Despite having an ongoing safety improvement process in place, Appleton Papers' manufacturing employees sometimes incur the kinds of musculosketal injuries associated with heavy manufacturing facilities. Appleton Papers creates product solutions through its development and use of coating formulations and applications and encapsulation technology. The company produces carbonless, thermal, security, inkjet and performance packaging products. Appleton Papers is headquartered in Appleton, Wisconsin, and has manufacturing operations in Wisconsin, Ohio, Pennsylvania, and the United Kingdom, employs approximately 3,400 people, and is 100 percent employee-owned.

While the company established its Appleton on-site wellness facility in 1994, it has been providing fitness opportunities for its employees since it began subsidizing employee memberships to the local YMCA in the 1940s. Appleton Papers' former chief executive officer, John P. Reeve, was then the company's personnel manager and the driving force behind a partnership between the YMCA and the company. Reeve had a strong belief in the value of exercise and the benefits of healthy employees to both the individuals and the company. His response to the YMCA's solicitation for money to build a new facility was to pledge that Appleton Papers would pay half the cost of a Y membership for employees, which it still does today. The boost in memberships helped the YMCA justify the 1940s expansion.

Reeve retired from the company in 1977 after 43 years of service. When the company dedicated its Appleton fitness facility as the John P. Reeve Wellness Center in October 1995, it was to recognize Reeve for his pioneering work in corporate fitness initiatives. "Our mission at the Wellness Center is the same one John Reeve had over 50 years ago: to promote the health and well-being of company employees and their families," said Meredyth King, occupational health nurse for the Appleton Plant. She added that the company took steps to ensure the success of that mission by staffing the facility with experts who are YMCA employees.

The Appleton Wellness Center occupies more than 4,000 square feet with an aerobics studio, cardiovascular exercise area, weight-training room, and physical rehabilitation room. The center offers four primary areas of programming: on-site physical rehabilitation, ergonomics/injury prevention, fitness, and education. A licensed athletic trainer, a certified physical fitness specialist, and a full-time assistant staff the center.

Physical Rehabilitation Program
Through the efforts of the licensed trainer, the center offers employees and their spouses rehabilitation programs for both work- and non-work-related injuries. Appleton Papers also provides employees with an on-site nurse practitioner who evaluates work-related injuries and consults with employees regarding non-work-related health concerns and wellness initiatives.

Nurse Practitioner Natalie Gauthier said the Wellness Center's services include ultrasound, electric stimulation, phonophoresis, iontophoresis, paraffin bath, and hot and cold treatments. "We offer a range of programs and treatments for employees that are not typically found in a corporate wellness center," she said.

There is a significant cost-avoidance benefit from providing on-site physical rehabilitation. Appleton Papers uses two factors to determine cost avoidance: the number of treatments performed and cost per session. In just 2003, the company had a cost avoidance of $205,000 by providing on-site physical rehabilitation services.

While the cost avoidance component is an attractive benefit, there are others, as well. Employees avoid paying the co-pay they would incur at an outside facility. Additionally, employees are not losing pay for the time spent traveling to or sitting in a waiting room at another facility. Perhaps the biggest benefit of being on site is the center's ability to accommodate employees' schedules. Dave Brown,former union president for the Appleton Plant's bargaining unit employees, said he appreciates the value of flexible scheduling. "The employees realize that we need to keep the machines running in order for the company to make money. However, they also realize their health and safety at work is very important," Brown said. "Sometimes the balance between production and health isn't equal. This is one reason that providing on-site physical rehabilitation is a great benefit. We understand that if an employee has a rehab appointment scheduled but can't get away from their machine, they can call the Wellness Center and usually get an appointment later that same day. I'm not so sure this would be the case at an off-site rehab clinic."

There is an additional benefit from how quickly treatment begins after an injury. "Providing on-site physical rehabilitation services has a number of benefits," Corporate Medical Director Dr. James Marotz said. "From my standpoint, it is extremely important that our Wellness Center staff be able to provide immediate treatments after an injury. With our center on site and staffed by a licensed athletic trainer, it enables us to begin the treatment program immediately, as opposed to going through the delayed time of the regular health care procedure. The broad based skills of our athletic trainer helps with returning the employee to work safely and in improved physical condition."

The center's staff develops therapeutic exercise programs to help employees recover from injury. By having the staff on site, a specific exercise program can be developed based on the nature of the injury and the job tasks the employee performs.

Because the physical rehabilitation services have been available, the staff has distributed satisfaction surveys to gauge attitudes toward the facility and the services available there. Feedback has been positive. Sally Feistel, the plant's union vice president, said the Wellness Center is playing a key role in reducing soft-tissue injuries by promoting the plant's behavioral safety process. "We promote the use of the Wellness Center to treat symptoms before they become lost-time accidents," Feistel said, "and the support from the Wellness Center staff has been excellent."

Ergonomics/Injury Prevention Program
The Wellness Center's injury prevention program focuses on job site and ergonomic analysis. The center's staff looks for the five ergonomic risk factors: awkward postures, excessive force, repetition, contact stress, and vibration. If staffers identify any of those risk factors, they will develop specific job modification recommendations based on such assessment tools as the NIOSH Lifting Equation, Snook Approach, Rapid Upper Limb Assessment, and Strain Index.

Through use of the NIOSH Lifting Equation, the Wellness Center staff identified two job tasks that put a number of employees at risk for lifting-related low back pain. One of the job tasks required employees to lift boxes weighing 35 to 80 pounds throughout the day. The center provided numerous options to Appleton Papers and eventually the company decided to install a vacuum hoist that virtually eliminates all lifting for that specific job.

Another job required employees to lift 50-pound bags of powder frequently during the workday. Staff suggested the product be converted into bulk bags to eliminate lifting the bags. The company implemented this solution, and now the employees use a fork truck to lift 1,000-pound bags of powder and just pull a string so the powder empties into a tank.

The injury prevention efforts have had a significant, positive effect on days away from work and worker's compensation claims. In the past three years, days away from work have decreased by 28 percent. As illustrated in the chart below, the number of comp claims for strains and sprains has continuously decreased since 2000.

The Wellness Center developed a plant exercise program to help workers exercise during their workday. The program places exercise equipment at the various workstations on the plant floor, enabling employees to exercise before, during, or after their workday. The exercise equipment consists of a stretching station and wall-mounted resistance bands.

Initially, the program was implemented in three departments. Results from a six-month follow-up survey indicate 81 percent of the employees using the equipment noted improved flexibility and an improved ability to perform their job. Additionally, 94 percent of employees exercising on the equipment had reduced muscle fatigue and reduced muscle soreness during the workday. The program was so well received in the three initial departments that Appleton Papers now has 22 exercise stations throughout the plant, allowing the more than 750 plant employees to have access to the equipment during their workday.

Educational Program
By offering easy access to injury prevention and general wellness information, the Wellness Center encourages employees to use the facility as an educational resource. Providing this service free of charge, the staff hopes to enhance its goal of having a proactive approach to injury management that prevents injuries from occurring. The staff offers educational programming on a number of topics, such as ergonomics, low back injuries, musculoskeletal disorders, new hire orientations, and a variety of health/wellness-related topics.

The ergonomic education is based on findings obtained during ergonomic walk-throughs and is specific to each department, based on the job tasks within that department. The staff will analyze each department and then apply general ergonomic principles to each. The low back and musculoskeletal disorder training is offered plant-wide. Throughout the year, the staff schedules guest speakers to present specialized topics that meet everyone's needs. Past topics have included gardening, big-game hunting, breast cancer awareness, teen sports conditioning, child car seat safety, and children's crafts.

Recently the center held an employee health fair that focused on men's health. During the fair, employees were offered a number of free services, including cholesterol testing, fitness assessments, body fat analysis, and blood pressure screening. The company's medical director lectured throughout the day on a variety of men's health topics.

Fitness Program
The center serves as a full-service fitness facility with a cardiovascular and weight-training area. The cardiovascular equipment available for participants includes treadmills, stationary bikes, elliptical trainer, stair-climbers, and a rowing machine. Weight machines and free weights are available. As part of developing a complete physical fitness program, the staff offers testing and evaluation of participants prior to and during the exercise program. The testing assesses current fitness levels to identify an individual's training needs. The center uses the YMCA's fitness assessment protocol.

The four areas of physical fitness testing include body composition, cardiorespiratory endurance, flexibility, and muscular strength and endurance. These tests provide important information about a person's fitness status and starting point for his or her exercise program. The staff encourages goal setting to help members reach their desired level of fitness. Fitness classes such as step aerobics, an abdominal and back strengthening class, strength and resistance training, and martial arts classes are available at no cost to help participants reach their goals.

Contributing to Long-Term Success
Through the numerous fitness, injury prevention, and rehabilitation programs the Wellness Center has helped Appleton Papers decrease the costs associated with work-related injuries for muscle strains, sprains, and overuse injuries. As illustrated in the chart below, overall costs for soft-tissue injuries have decreased by 22 percent in the past three years.

As insurance and health care costs continue to escalate, finding effective programs to prevent and manage injuries can be a unique contributor to a company's long-term success. Through its partnership with the local YMCA, Appleton Papers is taking real steps to reduce costs associated with injuries occurring at work and at home.

"The programs available at the Wellness Center are outstanding. The partnership between Appleton Papers and the YMCA demonstrates that a strong commitment to employee health and wellness can indeed have a positive effect for a company," said Michele Stellrecht, fitness director for the YMCA of the Fox Cities, Appleton YMCA. "We truly believe that the Wellness Center has helped make the workplace a safer place at Appleton Papers.

This article originally appeared in the September 2004 issue of Occupational Health & Safety.

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