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Building a holistic program

In any fire department firefighters are the most valuable — and vulnerable — asset. The overall health and wellbeing of firefighters must be maintained, like any other city asset, or they become disabled and rendered ‘out of service’.

Despite the importance, it can be a daunting task to consider creating a health and wellness program in a department with a very full work flow and competing priorities. The nature of much of your work is focused on reacting and responding to events/situations (e.g. putting out fires), which further complicates the situation. Before you know it, another fiscal year has come and gone and so has the opportunity to improve the health and wellbeing of your firefighters. To sum up why now is the time to take action, consider the inspiring wisdom found in this old Chinese proverb: “The best time to plant a tree was 20 years ago. The second-best time is now.” The following will provide you with some ideas to create, customize, and streamline your health and wellness program regardless of the size or type of your department. The focused investment of time upfront in getting a program off the ground will pay dividends for years to come.

■ CLARIFY THE MISSION
Consider the following questions: Why is it important for our department to create a health and wellness program now? Is it to help improve the overall health and wellbeing of our firefighters? Is it to give them further skills to be better equipped to manage stress and mitigate or even prevent mental, emotional, and physical injuries? Is it to boost morale, foster teamwork and help shift the culture? All of the above? Note that “save money in terms of reducing sickness and absence rates” was not mentioned as a reason why. Firefighters are human beings and the success of a program must be based on it being people-centric. If the only focus is on numbers, you will have a program doomed for failure from the outset. Tracking numbers such as sick days and absence rates can be useful for measuring progress and results but they must never be the primary focus. When a department defines and clarifies the reason “why”, the answer will act like a compass in providing direction for how your program is designed.

Question to consider: Who in your department is best suited to help to define and clarify the why?

Action: Consider creating a small mixed group of management and members.

■ CREATE A SHARED VISION
A successful program will require spending time looking at things from the strategic perspective, which in turn will give way to tactical operations for the program. It is critical that departments invest the time necessary to define what you want in your program and create a shared vision for what the program could look like. Enabling members and management to contribute their ideas either through crew input or through a small group made up of management and members is a fantastic way to brainstorm, discover emerging trends, themes, and patterns, and facilitate buy-in to the program. To start things off, one of the most useful documents that helped frame our program is the IAFC/IAFF Joint Labour Management Wellness Fitness Initiative (events.iafc.org/files/healthWell_WFI3rdEdition.pdf.pdf). This 30-year-old document still holds true today and provides important key aspects to consider in creating a program. We based our program on the following guiding principles as outlined in this document:

• Progressive wellness improvement
• Holistic approach
• Improves quality of life for the firefighters
• Positive and individualized
• Confidential
• Educational focus (non-punitive)

In addition to using these guiding principles as a framework, we chose a holistic approach by focusing on the four pillars for creating healthy and resilient firefighters: how they eat, move, sleep and think. We initially used a health risk assessment (HRA) that screens for nutrition patterns, movement habits, sleep hygiene, and psycho-social aspects. These results gave our great quantitative data to assess the overall health and wellbeing of our department. We were able to merge what we wanted to create with what the department needed. We continue to use this HRA annually as tool to measure and track progress as well as identify emerging patterns or areas for focus in our next year’s program. After five years, these are the pillars we base our education and training on and have also now included team building and leadership skill development.

Questions to consider: Acting ‘as if’ it is one or three years from now what do we want to be seeing, experiencing, feeling in our department? What will be different in our department because we have implemented a health and wellness program? What specifically do we really want to create? What one area if we were to focus on right now would give us the most positive impact? Where is the best place to start?

Action: Enable members to participate in the creation of your program.

■ CHALLENGE THE PROCESS
One of the hurdles to implementing a successful program is not getting stuck in self-defeating patterns of thinking and behaving. Some of the most detrimental statements in any workplace are “that’s not how we have always done things here” or at the first sight of an obstacle, “this will never work.” These statements stifle innovative solutions in the face of challenges. As part of challenging the process, being open to trying out new ways of doing things can be refreshing and rewarding. One of our first challenges was looking at how our department could make changes to the old schedule/routine to accommodate dedicated health and wellness training time while not impacting operations. With some creative thinking we were able to make amends to the schedule and have now further amended the schedule as each crew has different work flow demands.

Another common challenge is time and expertise. Time is a precious commodity and if designing and implementing a program is outside your skillset, it might be wise to hire an experienced health practitioner to help. Having an outside health professional to assist with creating, facilitating, and overseeing the program will also provide other benefits including confidentiality, providing a barrier between management and membership and improved and enhanced access to community resources. We have learned that the more flexible and adaptable we can be in our approach to our program, the better it is for all concerned.

Questions to consider: How else might we approach implementing this? How can we best implement this program without impacting our operations? What are our potential roadblocks and how can we best find solutions for them? In terms of resources, who or what else do we need to move this program forward?

■ MEASURE AND TRACK
A pattern that we have observed in many organizations is that they tend to react and throw resources towards ‘hot topic’ issues in the workplace without taking the time to be strategic in their approach (see creating a shared vision). They further compound the problem by failing to plan for how they will measure the results. This inefficient and ineffective strategy is equivalent to flushing money and resources down the drain.

It is imperative that departments consider what quantitative and qualitative metrics they will use to measure progress and track results. Being deliberate in this process helps to identify issues as they come up and allows departments to tailor and further tweak the program as they progress. For example, one of the primary quantitative metrics we use is the annual Health Risk Assessment (HRA). This is a metric that gives hard numbers on the average scores for a department for all the health markers. It ensures that our program is providing results that are trending in the right way and provides council with stats about our program which in turn ensures that our program continues to receive funding. When our level of participation in our program is down, our platoon health leaders communicate this to me (Wegwitz, registered nurse), who can assist in diagnosing and addressing the issue.

The following are examples of various quantitative and qualitative metrics for departments to consider using to measure results and track progress.

Quantitative measures

• Sickness and absence rates
• WCB claims
• Measuring B/P and pulse/weight
• Health Risk Assessments (annually)
• ProQOL (Professional Quality of Life) questionnaire (screens for compassion satisfaction versus compassion fatigue)
• Stress leave
• Physical and mental injuries

Qualitative measures

• Employee engagement in the program
• Satisfaction with program (surveys to elicit feedback; platoon health leaders feedback)
• Ownership and accountability for personal level of health and wellbeing
• Overall improvement of employee satisfaction (improved camaraderie and morale)
• Team focus versus individual focus (e.g. what’s in it for me)
• Decreased presenteeism (showing up to work even when sick)
• Increased productivity (presenteeism and productivity go hand in hand. As workers work more, exercise less, eat worse, stress more and sleep less they become less productive)
• Reporting less workplace stress

Questions to consider: How specifically will we measure progress and track results in our program? How will we know our program is successful? What will be our evidence criteria? What do our municipal stakeholders value or want/need measured?

■ TAKE ACTION
Often when setting up a program we wait too long to ‘get it right’ or over-analyze and get mired in the details. Creating a timeline can help with mapping out your program and makes taking action easier. In addition to a timeline, what else can be helpful is creating milestone markers. For example, if your timeline is for a year you might consider quarterly milestones and then defining what those benchmarks are. These milestones can also act as opportunities to measure progress and track results to assess whether you are moving in the right direction. Once you have a timeline established you can start breaking things down into smaller more manageable tactical action steps. The last part to taking action is to be sure you celebrate your wins. Celebrating wins can mean high fives, crew meals, verbal feedback, or even creating the “Healthiest Platoon of the Year Award” like we did, which leverages the healthy competition you’d find in any fire department. When you see members actively participating in the program, reinforce that behaviour with positive verbal feedback. Celebrating your wins all the way along will ensure that momentum doesn’t wane, and it will reinforce the positives. It helps everybody share in the victories instead of solely focusing on what is wrong or not working. It will allow those who are resistant to participate or slow to adopt the health and wellness program take the leap and participate.

Questions to consider: What three action steps can we take this week/month/quarter that will move our program forward? How specifically will we celebrate our wins? How else can we ensure positive momentum moving forward?

In conclusion, the health and performance potential of any firefighter depends on how they eat, move, sleep, and think on a consistent basis. A strategic focus on building mental fitness and improving general health practices will positively impact each firefighter’s potential, enhance performance, and improve their quality of life both on and off the job. This proactive and preventative approach aids in decreasing the incidence of mental and physical health injuries while improving morale, fostering team, and saving money. After all, healthy firefighters are resilient firefighters — and resilient firefighters are effective firefighters.

Chief Dave Cockle has been a career firefighter with the Oak Bay Fire Department for 30 years. He is a founding member and chair of the BC Earthquake Alliance and ShakeOut BC. Contact him at dcockle@oakbay.ca. Sara Wegwitz is a registered nurse who specializes in mental fitness and resilience training. She provides training and education to a number of fire departments across British Columbia and is the primary facilitator of the Oak Bay Fire Department’s wellness program. Contact her at sara@tailormakinghealth.ca.