Abstract
Background
The Workplace Health Achievement Index (WHAI) is a free online self-assessment tool that allows organizations to evaluate the comprehensiveness of their workplace health promotion program, identify opportunities for improvement, and benchmark their progress over time against their peer organizations. The WHAI was designed not only to help organizations identify which structures and processes they have in place to promote employee health, it also scores companies on the cardiovascular disease profile of their workforce using Life’s Simple 7, the American Heart Association’s (AHA) definition of ideal cardiovascular health. The WHAI is unique in the organizational scorecard landscape for assessing health outcomes and scoring companies on employee health outcomes. Another unique feature is that the WHAI is tied to a recognition program: Based on the total WHAI score achieved, companies are recognized nationally as bronze, silver, or gold. Companies can attain bronze and silver without submitting employee Life’s Simple 7 data; however, it is not possible to receive gold designation without securely submitting Life’s Simple 7 data to the WHAI’s online portal.
The WHAI scorecard is comprised of 55 questions that are categorized into 7 pillars or domains of best practice: (1) leadership, (2) organizational policies and environmental supports, (3) communications, (4) health promotion programs, (5) employee engagement, (6) community partnerships, and (7) reporting outcomes (Table 1). By completing the WHAI, organizations can evaluate to what extent they are implementing best practices and a dashboard report allows them to compare their results to organizations of similar size and industry sector.
American Heart Association WHAI Topic Areas.
Abbreviations: AHA, American Heart Association; WHAI, Workplace Health Achievement Index.
a The AHA WHAI scorecard also includes 3 scored items related to employee health outcomes data.
Development
The WHAI was developed in 2015 by a team of AHA staff and the AHA’s Workplace Health Steering Committee, a group of 15 science volunteer representatives from science and industry. The WHAI was called for by an AHA presidential advisory on workplace wellness recognition programs, which conducted a landscape review of industry programs, including AHA’s Fit-Friendly Worksite recognition program. 1 The review concluded that although most indices score the organizational structures and processes built to maintain worksite health promotion programs, these tools did not include an objective outcome measure of employee health. The advisory recommended that AHA update the Fit-Friendly Worksite program with a more comprehensive assessment including employee cardiovascular health as an outcome measure. American Heart Association staff conducted a landscape review and incorporated questions from the Fit-Friendly questionnaire complementing it with select peer-reviewed best practices available in the public domain, principally the CDC Worksite Health ScoreCard. 2 Throughout the development process, drafts were shared with the Workplace Health Steering Committee that provided feedback and suggestions. The WHAI was pilot tested with the AHA chief executive officer (CEO) Roundtable, a group of the nation’s largest organizations that have come together to pilot, test, and scale-up evidence-based solutions. The WHAI beta was launched in 2016 and is currently in its fourth year of implementation. The development of a second version is currently underway and is scheduled to be launched in 2021.
Administration
The WHAI is available at no cost as an online survey through a link on the AHA’s website. 3 A user guide is available online along with a pdf of the survey questions and instructions on how to submit employee health data. American Heart Association recommends that a team of people responsible for health, safety, and well-being work collaboratively to develop the correct responses for their organization. Organizations can submit employee health data automatically by utilizing the AHA’s My Life Check tool, a brief, 4-minute heart health assessment that provides a Heart Health Score based on Life’s Simple 7. Organizations may also submit employee health data securely to the WHAI by using the batch upload or aggregate data report template provided in the online portal. Organizations consult with their health insurer to obtain information on Life’s Simple 7 metrics in their population to complete the batch and aggregate data. Scorecard completion takes approximately 2 to 4 hours.
After submitting responses online, users can access a provisional WHAI online dashboard that shows their total Index score and subscores, as well as the organization’s aggregate cardiovascular health score if employee health data were submitted. The dashboards can be downloaded to a pdf. To evaluate their progress along the way, AHA recommends that organizations participate annually. This also allows for continuity of recognition.
Benchmarking
Currently, the WHAI provides users with free benchmarking data in users’ dashboards. Each metric, for example, the total WHAI score, also shows the performance of organizations of similar size and industry sector. In this way, participants can compare their year-over-year performance compared to their peers. Organizations also have access to free resources 4 and case studies from the CEO Roundtable. 5
Validation
In 2019, 938 companies completed the WHAI and 447 (48%) submitted employee health data. Organizations of different company sizes and industry sectors are well represented. A manuscript of the tool’s development, implementation, and benchmark data is currently underway for submission to a peer-reviewed publication.
In addition, Goetzel and colleagues used the WHAI to examine the cross-sectional association of WHAI aggregate scores with measures of employee health risks, disease prevalence, and medical expenditures. 6 Based on analysis of over 373 000 employees from 21 large employers, the findings showed that higher aggregate WHAI scores were associated with lower levels of health risks for 4 of the 7 Life’s Simple 7 risk factors. Higher aggregate scores were also associated with lower prevalence of cardiovascular diseases but also higher spending on the condition.
The WHAI is currently being updated through a process of review of the scientific literature. As part of that process, the new survey questions will be tested for their validity and reliability in partnership with an independent academic institution. Results will be made available in 2021 when version 2.0 of the assessment is launched.