With the help of a local private business owner, the Thurston County Steps program approached the Thurston County Chamber of Commerce about developing a joint venture aimed at private employers. The WorkWell Healthy Workplace Designation Program was developed during the first 6 months of 2006 to recognize the commitment and changes that employers made to support healthy eating and physical activity during work hours. The goal of the approach is to emphasize the many ways to bring about meaningful change within the workplace. Employers are invited to apply for recognition through the WorkWell Healthy Workplace Designation Program by documenting environmental and policy changes along with organizational commitment to health in the workplace from the previous year (8). Employers are recruited by direct marketing in e-mail, advertisement, and publicity on the Web sites of the chamber and the Thurston County Public Health and Social Services Department, in the chamber's monthly magazine, and through distributing program materials at chamber events.

The WorkWell program features 3 designation levels — bronze, silver, and gold. The bronze recognition is awarded to employers who demonstrate organizational support for changes to the work environment or culture that can affect healthy eating or physical activity. Examples of organizational support that qualify include expanding the organization's vision or strategic plan to incorporate employee health and fitness or starting a committee focusing on workforce health that allows employees in different job classes to assist in the design and implementation of plans for change. The silver recognition is awarded to employers who meet the criteria for bronze and have supported specific changes to the work environment that either 1) made healthier food choices available or more accessible to employees or 2) made engaging in physical activity during work hours an option or an easier choice for employees (11). The gold recognition is awarded to employers who have met the criteria for bronze and have supported changes that address both the healthy eating and physical activity criteria for silver. Types of qualifying efforts in the healthy eating category include creating a healthy food guideline for use when planning employer-sponsored events, having healthy food choices available in on-site vending or snack bars, and providing a refrigerator, microwave, and sink at no cost to employees. Examples of physical activity interventions include offering flexible break times and lunches on a rotating basis so employees can take advantage of physical activities, creating walking maps for destinations within 1 mile of the workplace, providing umbrellas for walking in rainy weather, and developing a policy that rewards employees who use a physically active way to travel to work. A review committee composed of local employers and Thurston chamber staff helped evaluate the applicants.

Recognized employers are given WorkWell decals that they can display on their entrance doors. The Thurston County Chamber of Commerce hosts a forum focused on awarding the designations, which in 2008 was attended by approximately 170 local employers. Employers are also honored in ways that communicate their unique approach to employee health and evidence-based strategies to their peers. Employers who receive the designation award are featured in an online video series promoted by the business community newspaper, a monthly magazine, and on the Thurston County Chamber of Commerce Web site.

The WorkWell approach for public employers involves a guided self-assessment and action planning process called Action Planning for a Healthy Workforce. This process was designed to support employers who are ready to take a closer look at key organizational issues that affect employee health and fitness. Thurston County Steps developed the self-assessment tool and related promotional materials with an advisory committee consisting of managers and staff from local public sector (government) employers of varying sizes and workforce compositions.

The Action Planning for a Healthy Workforce process focuses on chronic disease areas that are consistent with the Steps Program’s target areas and were supported by the DOH evidence-based state plans (physical activity and nutrition [11], asthma [12] and tobacco use [13]). The self-assessment tool highlights 3 key components of workforce health promotion: 1) expression of leadership support and commitment to employee health (14-18), 2) expansion of written polices or formal practices in the organization (11,17-19), and 3) environmental assets and supports throughout the workplace (11).

The assessment and action planning process assumes that meaningful, long-term change must focus on both individual behavior (ie, employees) and organizational-level action (ie, worksites and employers). The belief that people shape, and are shaped by, their work environment is a key tenet of this model (Figure). Interested employers participate in a 2-stage process that provides decision makers with information to plan changes that would most benefit their organizations and workforces. The process starts with the facilitated completion of a self-assessment tool that identifies organizational strengths in relation to current health-related policy and practices. Employers are then invited to participate in a facilitated action planning process that identifies workforce health strategies designed to fit the employer's needs.

The Healthy Workforce assessment tool covers 4 main topics: 1) workforce health promotion, 2) physical activity at work, 3) healthy eating during work hours, and 4) air quality in the workplace. This assessment provides insight around characteristics of organizations that have been linked to successful changes in workforce health, including leadership support for workforce health and capacity for promoting change; a work environment organized or designed to make healthy choices easier; and culture of the organization, as demonstrated through written policies, formal practices, and communication. The assessment tool was developed by Thurston County Steps staff with expertise in program development, strategic planning, and organizational assessment.

The assessment is designed to be carried out by an assessment team consisting of the workplace's employees, thus involving the population affected by the possible actions and assuring greater accuracy and reliability in the data collection. The workforce perspectives included on the assessment team are senior leadership or policy makers, middle management, employee benefits, bargaining units, building maintenance or facilities management, internal wellness groups, and contract managers (eg, managing the services provided by food vendors, other worksite suppliers). Employers set their own timeline for the planning process; however, a 6- to 10-week schedule is recommended. Only 2 meetings of the full assessment team are needed to complete the self-assessment: a first for orientation and a second for scoring after the assessment data has been collected. A 2-person team of outreach and assessment staff from Thurston County Steps facilitate both the assessment and action planning phases and prepare the assessment report for the organization. The process was piloted with the Thurston County Public Health and Social Services Department, then became available for use with public-sector employers throughout the county.

In 2007, DOH became the first partner with the Thurston County Steps program to implement the assessment and action planning process to identify priority areas in their own agency. DOH chose this process as a way to address environmental and policy issues in the agency's overall health and productivity work. The agency followed the process described above, and Thurston County Steps reported results of the assessment back to DOH leadership. This report and the facilitation provided by Thurston County Steps helped DOH develop a baseline and prioritize work from its overall comprehensive plan. Thurston County Steps staff worked with DOH Health and Productivity Team members to develop an action plan based on identified agency priorities.

In the first 2 years of the initiative in the private sector, 26 employers representing small and large workforces totaling approximately 4,700 employees, were awarded WorkWell designations (Table). Awardees received recognition for implementing changes that encouraged physical activity and healthy eating, such as making stairwells more appealing for physical activity, low-cost or no-cost healthy meals for employees, and healthy foods for meetings. Nineteen of the employers have been recognized with gold designation. From the first to the second year of the program, the number of employers who applied for recognition doubled (Table). Participating employers included banks, credit unions, social services agencies, a hospital, a casino, and several city and county government agencies.

The Thurston County Chamber of Commerce broadened its vision to encompass workplace health and began to feature WorkWell as one of the main programs for its members and other employers. The chamber signed a memorandum of agreement with Thurston County Public Health and Social Services Department to continue the collaboration around workplace health promotion. The chamber's Web site now promotes WorkWell and provides employers with examples of organizational support and healthy eating and physical activity options that they can implement to reach different designation levels. The WorkWell Healthy Workplace Designation Program was designed so that the Thurston County Chamber of Commerce became the lead entity for its implementation, further sustaining this valuable employer resource. The partnership will be sustained through funding provided by the US Department of Health and Human Services, Office on Women's Health Advancing System Improvements to Support Targets for Healthy People 2010 (ASIST2010) program.

Through September 2008, in addition to Washington State Department of Health and the Thurston County Public Health and Social Services Department, another state agency, a regional education service district, and a local government employer — together employing approximately 4,400 people — have completed the assessment, which demonstrates the versatility of this approach and its applicability to diverse public employers (Table). Three current employer partners are considering 18 workplace environment and policy changes.

Thurston County Steps has developed a sustainability plan for the public sector element of the WorkWell initiative. This plan includes exploring the interest among other public employers, particularly state agencies, in providing funding for the staff support provided by the Thurston County Public Health and Social Services Department. Thurston County Steps is also examining ways so that others can carry out the assessment and action planning process or repeat the process to reassess the workplace environment and policies as changes are being made. Thurston County Steps also revised the self-assessment tool based on comments and suggestions gathered during the first 2 years of its use.