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The term "disenfranchisement" usually refers to a segment of voters who feel their opinions have not been heard or that their needs aren’t being considered in some way by the government. Segments of your wellness program target audience can feel the same way if program planning does not consider their unique needs.

When employees do not feel heard, their enthusiasm wanes and participation drops. From a senior management perspective, funding may be withdrawn because the program is not meeting their priorities. Disenfranchised middle managers can create obstacles to employee participation or attendance during the work day. Unions can resist efforts to change policies and the workplace culture. Provider networks may not support initiatives that require their involvement.

Quality management (QM) tools provide ways for decision makers to listen and respond to the "customer." Any individual or group who benefits directly (or indirectly) from wellness program services is a customer. For example, not only is the CEO, middle management and blue-collar worker wellness program customers, but so are the unions, insurance carriers and human resources department. With such diverse backgrounds and interests, customer expectations for a successful wellness program could vary significantly.

The Programming Decision Matrix (PDM) helps wellness managers overcome this challenge. It keeps customers’ priorities in perspective during the strategic planning process. Since initiatives are chosen specifically to meet customer needs, the PDM helps justify budgets and expenditures. As a result, customers value the program which means better participation and management support.

Prior to using the PDM, customer criteria must be gathered through needs assessments and surveys.

• What do they desire in the way of products and services?
• What characteristics should these initiatives have?
• How do they want these initiatives presented?
• What barriers would limit their participation?
• What DON’T they want?

Invariably, there will be common themes in their expectations. Try to group similar threads together into a single simple statement for use in the decision matrix.

At a minimum, use the PDM to develop programming objectives that support management’s expectations while providing wellness products and services desired by the employees. With that in mind, The table below illustrates a PDM outlining the hypothetical criteria of XYZ Company’s senior management, employees and the strategies to support both.

Programming Decision Matrix
	Management Criteria
	Control Healthcare Costs	Identify Group Risks	Productivity	Raise Morale
Employee Criteria
Make it fun	Incentive program to reduce use of healthcare system	"Beat The Boss" assessment competitions. Prizes for best scores	Initiate health and safety competition with prizes	Fitness day with inter-office competition
Learn personal health risks	Lecture series based on HRA results	HRA program with feedback loop	Develop special work hardening program based on HRA results	Offer private fitness assessments during Fitness Day event
Minimal off-duty time	"Lunch and Learn" health risk programs	Health screen and counseling done during staff meeting	Provide "comp" time for personnel attending off-duty	1-hour Tai Chi classes starting ½ hour before end of work
Ensure privacy of information	Compile group utilization reports only	"Sanitize" group HRA information so individuals cannot be identified	Provide work stress programs. Code records instead of names	Publicly recognize class success (with permission)

Developing Wellness Strategies for the XYZ Company

In the needs assessment employees said their most important wellness program criteria (listed down the left-hand side of the PDM) were that:

• It be fun
• They could learn their personal health risks
• Most programs be offered during the workday
• Information on their health risks and other behavior problems is kept private

Management’s expectations (listed across the top of the PDM) for the health promotion program included:

• Help control healthcare costs
• Determine group health risks
• Improve productivity
• Raise morale

Note: The number of boxes in the matrix can be adjusted as the number of criteria dictates.

Program planners developed at least one strategy for each management and employee expectation and placed it in the appropriate PDM box. For example, the top left-hand box calls for an incentive program to reduce use of the healthcare system. Details of this strategy could include the use of a self-care manual to discourage inappropriate use of the healthcare system and a periodic raffle for a luxury vacation to employees who keep their annual healthcare costs below a certain level. Obviously, a raffle for a vacation would be fun, thus meeting the employee’s criterion; and the projected reduction of inappropriate use of the healthcare system would meet management’s criterion of controlling healthcare costs.

In another example, the second box on the bottom row states that individuals will not be identified in health risk appraisal group reports. This meets the employees’ criterion for privacy of information, while still providing management with useful group information on health risks.

Once there is at least one programming objective in each box of the PDM, the wellness team develops related programs, products and services to be offered during the year. Managers market the initiatives and activities developed from this exercise to employees by illustrating how each strategy meets one or more of their criteria. When presenting the proposal to management for funding and support, the wellness manager emphasizes how the strategies meet management’s criteria.

Other Uses for the PDM

Other customer segments to evaluate using the PDM include:

• Cross-cultural, gender, age or ethnic criteria
• Needs from multi-sited organizations
• Needs of shiftworkers
• Differing needs among large departments or lines of business
• Families and retirees

Evaluate your indirect customers too. What needs to be in place for vendors and service providers to better support the program? Survey food service personnel, the healthcare provider network, third-party wellness contractors, and community agencies. Use the PDM to develop strategies that best meet everyone’s criteria.

As a side note: A variation of the PDM can be useful in classes on life-planning or retirement planning. This is especially effective when working with couples or families. Take the participants through an exercise to define their criteria for the marriage, family, retirement … whatever is appropriate. Oneperson’s criteria goes across the top axis and the other person’s criteria goes down the left-hand axis. The couple (or family) then works together to develop strategies that meet both of their expectations.