UTILIZATION OF EMPLOYEE WELLNESS PROGRAM

BY THE STAFF MEMBERS AT NATALSPRUIT

HOSPITAL

DR MAKGABO JOHANNA MANAMELA

A RESEARCH REPORT SUBMITTED TO THE FACULTY OF HEALTH SCIENCE,

UNIVERSITY OF THE WITWATERSRAND, IN PARTIAL FULFILMENT OF THE
REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH IN THE
FIELD OF THE HOSPITAL MANAGEMENT

JOHANNESBURG 2010
DECLARATION

I MAKGABO JOHANNA MANAMELA, declare that this research report, except that
which is listed and acknowledged, is my own work. It is being submitted for the
degree of Master of Public Health (Hospital Management) at the University of
Witwatersrand, Johannesburg. It has not been submitted before for any degree or for
any examination at this or any other university.

________________
October 2010

ii
DEDICATION

I dedicate this work to:

 My sons: Kenny and his wife Karabo, Thapelo and Phenyo and their
daughters: Makosha, Mathapelo, Letago and Keamogetswe, for their
encouragement, understanding and support throughout my studies, even in
unbearable situations.
 My mother Seemole Phuti, my brother George, my sister Rosina and their
families for encouragement to pursue learning even in difficult situations.
 My friends, especially Nkomori for continuous support and accompaniment to
attend evening and library studies.

iii
ACKNOWLEDGEMENTS

I thank God Father for His faithful love, grace, mercy and wisdom. He guided me to
carry on with my studies until all requirements were fulfilled. His presence was
encouraging throughout.

I also wish to thank the following people for their contributions in my study:
 Dr Adonis, my promoter, for expert advices, guidance, support, patient and
encouragement throughout the research study.
 Dr D Basu, Dr M Govender and Mr ME Letshokgohla for inspirations,
guidance and encouragement throughout the study.
 Natalspruit Hospital management, Employee Wellness Clinic staff members
and the research committee for supporting me throughout my study.
 Department of Health Authorities, both National and Gauteng Province for
financial assistance and fifty, fifty study leave.
 All my colleagues, friends and relatives who contributed towards my degree, I
salute you all.

iv
ABSTRACT

Background: In 2006 the Gauteng Department of health endorsed a Wellness

Program Policy. The policy was introduced and implemented in all Gauteng Province
Hospitals. The policy spells out the integrated model of wellness program. The focus
is to promote wellness, healthy lifestyle and assist the staff members who are ill
while at work place. The department found it crucial to ensure that the staff members
are well cared for in order to be productive.

Aim: To describe the utilization of the various components of the wellness program
by the staff members and to describe the outcome thereof.

Methodology: The research design was a quantitative, cross sectional retrospective

record review. The analysis focused on the records of the staff members of
Natalspruit Hospital, who utilized the wellness program services from January to
December 2009. The scope of the study covered all five components of wellness
program as outlined by the Gauteng Department of Health Wellness Program Policy.
Data was collected and analysed from 941 entries in the Wellness Clinic records.

Conclusion: This research found that the average number of staff visits during the
study period was 80.1(SD 22.1) which represents 80% of the total staff complement
and that actual percentage of staff who utilized the service is much lower. However
during the last month of the period under study attendance rate represented 5.8% of
total staff establishment. The majority of the staff members were women (90%);
female subjects were significantly younger than male subjects, p <0.01 (Mann
Whitney‟s test). The most professional and occupational categories that used the
services were the nurses. The components that were mostly utilised was Birth
control (48.9%); specifically for family planning, followed by the Occupational Health
and Safety component in the area of Hepatitis B (11.5%) and needle prick (3.9%).
The majority of the staff members continued with the services in the clinic (86.9%)
while very few staff members were referred out of the clinic (5.3%) to the casualty/
out- patient department, court and ICAS. Only (7.76 %) of cases were resolved. The
majority of the staff members utilized the organization and climate for management

v
of health related problems component, especially in the services of birth control for
family planning section. It seems a waste of resources to have an entire wellness
program where staff members are mostly using it primarily for family planning,
therefore the research described the basic requirements for effective EWP and also
the importance of capacity needed for effective policy management, then suggested
the comprehensive components. The report findings could benefit the Government
in planning and operations of other Wellness Programs across the country.

vi
TABLE OF CONTENT

DECLARATION ...........................................................................................................ii
DEDICATION ............................................................................................................. iii
ACKNOWLEDGEMENTS ..........................................................................................iv
ABSTRACT ................................................................................................................ v
TABLE OF CONTENT............................................................................................... vii
LIST OF FIGURES .....................................................................................................xi
LIST OF TABLES ...................................................................................................... xii
GLOSSARY OF TERMS .......................................................................................... xiii
LIST OF ABBREVIATIONS ...................................................................................... xvi
CHAPTER 1 ............................................................................................................... 1
INTRODUCTION ........................................................................................................ 1
1.1 BACKGROUND ............................................................................................ 1
1.2 PROBLEM STATEMENT .............................................................................. 2
1.3 JUSTIFICATION FOR THE STUDY.............................................................. 3
1.4 RESEARCH QUESTION ..............................................................................3
1.5 AIMS AND OBJECTIVES.............................................................................. 3
1.5.1 AIM ......................................................................................................... 3
1.5.2 OBJECTIVES ..................................................................................... ....4
1.6 SUBSEQUENT CHAPTERS ......................................................................... 4
1.7 SUMMARY OF THE CHAPTER.................................................................... 5
CHAPTER 2 ............................................................................................................... 6
LITERATURE REVIEW .............................................................................................. 6
2.1 UTILIZATION OF WELLNESS PROGRAM, AN INVESTMENT FOR THE
ORGANIZATION ........................................................................................................ 6
2.2 MAJOR WORK CHALLENGES, NECESSITATING IMPLEMENTATION OF
WELLNESS PROGRAM ............................................................................................ 9
2.3 ORGANIZATIONAL STRESS ..................................................................... 10
2.4 ORGANIZATION CULTURE ....................................................................... 11
2.5 ORGANIZATIONAL CHANGE .................................................................... 12
2.6 BENEFITS OF UTILIZATION OF THE EWP............................................... 12
CHAPTER 3 ............................................................................................................. 15

vii
METHODOLOGY ..................................................................................................... 15
3.1 STUDY DESIGN ......................................................................................... 15
3.2 SETTING..................................................................................................... 15
3.2.1 NATALSPRUIT HOSPITAL .................................................................. 15
3.2.2 THE HOSPITAL STAFF ESTABLISHMENT ......................................... 16
3.3 SCOPE OF THE STUDY ............................................................................ 17
3.4 STUDY POPULATION ................................................................................ 17
3.5 STUDY SAMPLE ........................................................................................ 18
3.6 PILOT STUDY............................................................................................. 18
3.7 DATA MANAGEMENT ................................................................................ 18
3.7.1 INSTRUMENT ...................................................................................... 18
3.7.2 DATA COLLECTION ............................................................................ 18
3.7.3 DATA ANALYSIS ................................................................................. 19
3.7.4 STATISTICAL TESTS .......................................................................... 19
3.8 ETHICAL CONSIDERATION ...................................................................... 19
CHAPTER 4 ............................................................................................................. 21
RESULTS................................................................................................................. 21
4.1 RESPONSE ................................................................................................ 21
4.2 STAFF ATTENDANCE ............................................................................... 21
4.3 DEMOGRAPHIC PROFILE ......................................................................... 23
4.3.1 AGE ...................................................................................................... 23
4.3.2 GENDER .............................................................................................. 23
4.4 OCCUPATION ............................................................................................ 23
4.5 WORK SECTION OF THE SUBJECTS ...................................................... 24
4.6 PROFESSION OF THE SUBJECTS ........................................................... 26
4.7 TYPE OF VISIT TO THE CLINIC ................................................................ 28
4.8 COMPONENT ATTENDED......................................................................... 28
4.9 PROFESSION AND COMPONENT ATTENDED........................................ 30
4.10 REASONS FOR VISIT TO THE CLINIC ..................................................... 31
4.11 PROFESSION AND REASONS FOR VISIT ............................................... 33
4.12 OUTCOME OF VISIT TO THE CLINIC ....................................................... 35
4.13 OUTCOME OF THE SERVICE ACCORDING TO THE SERVICES
ATTENDED .............................................................................................................. 36

viii
CHAPTER 5 ............................................................................................................. 38
DISCUSSION ........................................................................................................... 38
5.1 INTRODUCTION......................................................................................... 38
5.2 CLINIC ATTENDANCE ............................................................................... 38
5.3 PROFILE OF SUBJECTS ........................................................................... 39
5.3.1 DEMOGRAPHIC PROFILE .................................................................. 39
5.3.2 PROFESSIONAL AND OCCUPATIONAL PROFILE ............................ 40
5.3.3 WORK PROFILE .................................................................................. 40
5.4 COMPONENTS UTILIZED.......................................................................... 41
5.5 OUTCOME BY THE SERVICES ................................................................. 43
5.5.1 UNRESOLVED/ CONTINUATION ........................................................ 43
5.5.2 RESOLVED CASES ............................................................................. 44
5.5.3 REFERRED TO OPD/ CASUALTY ...................................................... 44
5.5.4 REFERRED TO ICAS........................................................................... 44
5.5.5 REFERRED TO COURT ...................................................................... 45
CHAPTER 6 ............................................................................................................. 46
CONCLUSION AND RECOMMENDATIONS........................................................... 46
6.1 CONCLUSIONS RELATED TO THE OBJECTIVES OF THE STUDY ....... 46
6.1.1 DETERMINATION OF THE PROPORTION OF STAFF MEMBERS
WHO UTILIZED THE EWP DURING THE STUDY PERIOD ............................ 46
6.1.2 DESCRIPTION OF THE DEMOGRAPHIC PROFILE OF THE STAFF
MEMBERS WHO UTILIZED THE EWP ............................................................ 46
6.1.3 DETERMINATION OF THE UTILIZATION RATE OF VARIOUS
COMPONENTS OF THE EWP DURING THE STUDY PERIOD ...................... 47
6.1.4 DESCRIPTION OF THE OUTCOME BY THE SERVICE COMPONENT
RENDERED TO THE STAFF MEMBERS WHO UTILIZED THE WELLNESS
PROGRAM DURING THE STUDY PERIOD .................................................... 47
6.2 LIMITATIONS.............................................................................................. 47
6.3 RECOMMENDATIONS ............................................................................... 48
6.4 USE OF FINDINGS OF THE STUDY ......................................................... 50
6.5 FUTURE RESEARCH ................................................................................. 50
6.6 SUMMARY AND CONCLUSION ................................................................ 51
REFERENCES ......................................................................................................... 52

ix
APPENDICES ............................................................................................................ 1
APPENDIX A: ETHICS CLEARANCE CERTIFICATE ............................................... 1
APPENDIX B: APPROVAL FROM POST GRADUATE COMMITTEE ....................... 2
APPENDIX C: APPROVAL FROM NATALSPRUIT HOSPITAL MANAGEMENT ...... 2
APPENDIX D: DATA COLLECTION TOOLS ............................................................. 2

x
LIST OF FIGURES

Figure 3.1 Location of Natalspruit Hospital............................................................. 16

Figure 4.1 Staff Attendance at the wellness clinic for the year 2009 as compared with
the staff establishment and the total posts filled ....................................................... 22
Figure 4.2 Occupations of the subjects .................................................................... 24
Figure 4.3 Work section of the subjects ................................................................... 26
Figure 4.4 Type of the visit ....................................................................................... 28
Figure 4.5 Component attended ............................................................................... 29
Figure 4.6 Profession and component attended ....................................................... 31
Figure 4.7 Reasons for visit to the clinic (n= 941) .................................................... 33
Figure 4.8 Outcome of the visit to the clinic.............................................................. 35
Figure 4.9 Outcome of the services according to the section attended .................... 37
Figure 5.1 Requirements for effective Employee Wellness Program ....................... 42
Figure 6.1 Capacity for effective policy management ............................................... 48
Figure 6.2 Organization relevant/culture components .............................................. 49

xi
LIST OF TABLES

Table 3.1 The hospital staff establishment categories.............................................. 17

Table 4.1 Proportion of staff members who attended EWP clinic ............................. 22
Table 4.2 Age and gender of the subjects (n= 941) ................................................. 23
Table 4.3 Occupation of the subjects (n= 941) ......................................................... 24
Table 4.4 Work section of the subjects (n= 941) ...................................................... 25
Table 4.5 Profession of the subjects (n= 941) .......................................................... 27
Table 4.6 Type of visit to the clinic (n= 941) ............................................................. 28
Table 4.7 Component attended (n= 941) ................................................................. 29
Table 4.8 Profession and Component attended (n= 941) ......................................... 30
Table 4.9 Reasons for visit to the clinic (n= 941)...................................................... 32
Table 4.10 Profession and reasons for visit (n= 941) ............................................... 34
Table 4.11 Outcome of visit to the clinic (n= 941) .................................................... 35
Table 4.12 Outcome of the services according to the section attended ................... 36

xii
GLOSSARY OF TERMS

CHANGE- change is the process of becoming different, of moving from the known
state of affairs or familiarity of oneself to the unknown or unfamiliar situation
(Engbers, 2007: 10).

CONTINUATION- indicates that the problem for which the services were sought for
has not been solved and the staff member had to continue coming for the services
during the study period to improve their health (Fowler, Fowler & Allen, 1992: 248).
.
COURTS- referred to the institution where there are judges or other persons acting
as tribunal in civil and criminal cases. In this study cases that required a court of law
were referred to courts for further management (Fowler, Fowler & Allen, 1992: 266).
.
ICAS- referred to as the name of the company contracted by Gauteng department of
health to assist in the management of EWP cases that the local appointed staff
members at the hospital or districts are unable to solve due to lack of the skills in that
area (Department of health, 2006).
.
INVESTMENT- a purchase of a financial product or item of value with the
expectation of favourable future or the commitment of money for property acquired
for future income (v Fourie, 2010: 17). In this study investment is seen as a long term
wellness implementation plan where the organization links its strategic initiatives to
protect human resources from ill health by putting more funds in the implementation
of wellness program so as to ensure that the staff members remain healthy and
serve the organization for a longer time without suffering from preventative work
related and to some extend personal preventative health problems.

ORGANIZATIONAL CULTURE- a uniformed, stereotyped manner of doing things by

specific group of people in a specific work environment that they identify themselves
fully with the organisation (Lim, 1996:16; Baron, 1994: 11).

REFERRED- indicates that the problem for which the services were sought for has

xiii
not been solved but needed services rather than the one the section is providing.
The staff members are given referral letters to visit the section or organizations that
provide the highest level of services (Department of health, 2006).
.
RESOLVED- indicates that the problem for which the services were sought for has
been solved (Fowler, Fowler & Allen, 1992: 1025).

STRESS- the inability to cope with the aspect of life that affects one‟s mental,
physical, emotional and spiritual wellbeing, leaving the individual with the feeling of
intense overload. Physical and mental exhaustion can occur which lead to
deterioration and diminished problem solving ability or poor functioning (Cunningham
& Cookson, 2009: 19).

UNRESOLVED - indicates that the problem for which the services were sought for
has not been solved (Fowler, Fowler & Allen, 1992: 1314).

UTILIZATION OF WELLNESS PROGRAM- the action taken by the staff members

by visiting the wellness section with the aim of being assisted by the staff appointed
in the section, either to manage own or work related health threat (Department of
health, 2006).

WELLNESS PROGRAM- comprehensive services designed to promote and

maintain the good health of the employee and offer benefits and activities such as
training, fitness, occupational and health services, addressing other health related
problems, provide counselling services and encourage the employees to take the
responsibility to remain healthy (Department of health, 2006).
.
WELLNESS PROGRAM COMPONENTS- refers to the services that are provided in
the wellness section such a Human Immune Virus/ Acquired Immune Deficiency
Syndrome, Occupational Health and Safety, management of health related
problems, psychosocial problems and other work related problems (Department of
health, 2006).

xiv
WELLNESS PROGRAM POLICY- a policy developed by the organization with the
aim of promoting the well being and health of the workers by improving the working
conditions and reducing the causes of ill health related to work and, promoting the
working environment as a source of a better health (Department of health, 2006).

xv
LIST OF ABBREVIATIONS

EWP Employee Wellness Program

HIV Human Immune Virus
AIDS Acquired Immune Deficiency Syndrome
EAP Employee Assistance Program
OHS Occupational Health and Safety
ICAS The name of EWP company contracted by the Gauteng
department of health to further manage sophisticated EWP cases

xvi
 CHAPTER 1
INTRODUCTION

The purpose of this study was to describe utilization of various components of the
Employee Wellness Program and describe the outcome thereof, during a one year
period (1 January 2009 – 31 December 2009). This introductory chapter covers the
background to the study, statement of the problem, research question, aims and
objectives and outlined subsequent chapters.

1.1 BACKGROUND

Gauteng Department of Health has a vision statement that emphasis “Health for a
better life.” The department strives to maintain highest possible quality care to
accomplish this vision. This can only be achieved through commitment of staff
members in the department. Therefore the department seeks to invest into health,
wellbeing and safety of the employees; this is filtered in the department‟s mission of
creating positive work environment, listen and communicate with the staff to ensure
that the work environment is free from harm to their health and wellness. The
department then developed policy guidelines on the implementation of wellness
program. The policy spells out the integrated model of wellness program that
includes: HIV/AIDS workplace employee assistance program, occupational health
and safety program, organization and climate for management of health related
problems, psychosocial program that address aspects such as substance abuse,
trauma, stress, organizational tension, dynamics of family matters, money problem,
depression and any other psychosocial/health problems affecting the staff members
at work.

The focus of the above policy is to promote wellness, healthy lifestyle and assist the
staff members with illness while at work place. The policy is implemented in all
Gauteng hospitals, clinics and district health services (Gauteng Department of
Health, 2006). It is a fact that the socio-economic conditions, chronic diseases and
other disease thrusts such as HIV/AIDS are challenges in South Africa. Gauteng
province is not exceptional. The working group is also affected by the challenges.
1
The challenges may be personal or organizational related but has an effect on the
staff members‟ well-being and productivity.

The wellness program was established in Natalspruit hospital according to the

departmental policy guidelines. Natalspruit Hospital program was established in
2003 and the policy was finally approved in 2006 (Gauteng Department of Health,
2006), free of charge to all staff members appointed in the Department and their
family members.

The program aimed to assist the employees to remain healthy and also address their
well being problems. In the year before the study period, it was found that sizeable
proportion (75%) of the staff members did attend the wellness clinic. Out of a total of
1358 staff members compliment 962 recorded to have attended the services
(Natalspruit Hospital Annual Report, 2009: 50). It was however unclear what the
major reasons where for the visits and whether the wellness program was indeed
successful in managing the employee‟s problems. It was on this note that the study
aimed to describe the utilization of various components of the wellness program by
the staff members in Natalspruit hospital and also identified which areas utilized
more than others as well as outcome by the services. The study excluded utilization
of the wellness program by the family members of the staff members.

1.2 PROBLEM STATEMENT

The hospital has a well established wellness program, and follows the programs as
prescribed by the department. Management at the hospital however are unsure of
how effective this program is. The hospital is also still plagued with several employee
related problems like stress, fatigue and high absenteeism. Since employee wellness
programs should ideally impact positively on these aspects, management was
interested to know just how well the program is actually doing.

2
1.3 JUSTIFICATION FOR THE STUDY

In 2009 Natalspruit hospital staff establishment was 1817, of which a total of 1358
posts were filled, that was 75% at the end of the 2007/8 financial year. The staff
members are the pillars of the organization. Service delivery depends on the
commitment of the staff members. Healthy staff members are more likely to present
more positive attitude to increase and improve productivity level. The implementation
of the EWP gives the staff members an opportunity to come to work even when they
have health and psychosocial problems knowing that they would be assisted at work.
Those with chronic illnesses and urgent health problems are also assisted in the
EWP section when need arise. Wellness programs at the workplace require a
significant investment in terms of resources like staff, equipments, health awareness
material and premises. This type of investment should ideally create a return of
investment through increased staff productivity and decreased absenteeism in the
long-term. Evaluating the rate of utilization and outcomes would give a clearer
indication of the possible benefit of the program.

The process aimed to assist the management to understand the status of the service
regarding its effectiveness and efficiency, so that they could then re-plan
accordingly. The organizational leaders would then be able to determine the extent
of usage of the program components and make informed decisions during the
development of strategic plans, including the resource allocations for the future.

1.4 RESEARCH QUESTION

Is utilization of various components of the EWP by the staff members at Natalspruit

Hospital optimum and what are the outcome thereof?

1.5 AIMS AND OBJECTIVES

1.5.1 AIM

To describe utilization of various components of the EWP and the outcome thereof
3
during a one year period (1 January 2009 – 31 December 2009)

1.5.2 OBJECTIVES

 To determine the proportion of staff members who utilized the EWP during the
study period.
 To describe the demographic profile of the staff members who utilized the
EWP.
 To determine the utilization rate of various components of the EWP during the
study period.
 To describe the outcome by the service component rendered to the staff
members who utilized the wellness program during the study period.

1.6 SUBSEQUENT CHAPTERS

Background to the research has been discussed and objectives defined in this first
chapter. The following chapters are:

Chapter two: Literature review

The purpose of the literature review was to explain and discuss concepts related to
the research and to search for solutions to the research problem.

Chapter three: The research methodology

The chapter describe the research methodology, methods and techniques used in
this study.

Chapter four: Presentation of the results

This chapter deals with the analysis of the findings of the study relating to the aims
and objectives.

Chapter five: Discussion

In this chapter the findings of the literature are integrated with the results obtained
from the analysis of data in order to address the aims and objectives of the study.
4
Chapter six: Conclusion and recommendations
This constitute the final chapter of the report and draw conclusions from the research
related to the aims of the study, makes the recommendations and suggests areas for
future research in the field of EWP in the department of health.

1.7 SUMMARY OF THE CHAPTER

The introductory chapter covered the background to the study, the motivation for the
research, statement of the problems and the objectives of the study. Lastly it
provided a summary of the subsequent chapters that make up this research report.

5
 CHAPTER 2
LITERATURE REVIEW

In this chapter relevant search on the utilization of EWP is discussed. In addition to

the published literature, information from various unpublished sources was also
reviewed.

2.1 UTILIZATION OF WELLNESS PROGRAM, AN INVESTMENT

FOR THE ORGANISATION

Corporate organizations need to invest in an organized, structured corporate

wellness program headed by a qualified health care professional (Simpson, 2003:
122). A well established program attracts the staff members and should assist the
organization by generating interest in the staff members to use the service. This may
yield good returns for the organization because the staff members who participate in
wellness programs often feel that they work for an organization that cares about their
wellbeing.

Organizational leaders should be encouraged to include the EWP in their strategic

plans and consider EWP as one of their deliverables. When they analyse and
evaluate the services rendered, the EWP implementation process, its functional
aspects and outcomes must be included. Evaluation models must consider the
employee as central to the evaluation.

Employees spend up to 60% of their time at work. From time to time these workers
may experience health and work related problems, some are easily realized and
managed whilst others, although realized, are difficult to manage and require special
intervention. Some problems are personal while others may be due to working
conditions. The impact of work on the health of the staff members cannot be
underestimated. The worker‟s problems may lead to absenteeism, tardiness, high
accidents rates, poor business relations, poor decision making and overall decline on
work performance. Therefore if the companies value the wellness of their staff
members they will ensure that they are supported to address the above challenges.
6
One strategy used to ensure that the staff members are supported is the
implementation of the EWP. Therefore it is important that the organizations integrate
the program into the existing corporate structure (Ginn & Henry, 2003: 25), and
regularly analyse and assess the effectiveness of the services, checking which
components were utilized most often and its effectiveness. The EWP should provide
services such as HIV/AIDS workplace employee assistance programme,
occupational health and safety program, organization and climate for management of
health related problems that requires the program to concentrates on physical ill
health of the staff members while they are in the work environment; psychosocial
program that address aspects such as substance abuse, trauma, stress,
organizational tension, dynamics of family and monetary matters, depression and
any other psychosocial problems affecting the staff members at work. Once people
are employed they have work life and home life. Therefore the organizations need to
have employee‟s health and wellbeing programs that focus on work life balance. The
EWP serves as an investment in human capital development and can lead to a
greater organizational success. Conditions at work such as communication
breakdown, unclear objectives, lack of purpose and unrealistic targets are
challenges and contribute to workers devastation at work. Good quality targets are
missed when staff turnover increases. The EWP program implementation results will
indicate to the leadership when the staff members are negatively affected by these
conditions.

Many organizations appoint a huge number of employees, and provide allowances

such as medical aids for their health care. In most cases medical aids caters for the
illness than for prevention of the diseases. It is important for these organizations to
ensure that ill health is prevented and the employees are taken care of. Cost on
medical claims will be reduced if illnesses are prevented. Bello, Clausan, Green &
Morrison (2007:18) cited out that some organisations spend 2.8 million dollars on
medical claims while their productivity loss is 10. 3 million dollars by the same staff
members. Medical claims can be reduced if the demands for medical consultations
are reduced. This is possible if the staff members first seek services in the EWP.

The organisations must drive the program. In his study Rochowics (1990) found that

7
some organizations would consider implementing the wellness program only if the
staff members can pursue it. In these incidents, it appears that leadership does not
value the wellness program. Once the leaders value the services and include it in
their strategic plans and implement, monitor and evaluate the utilization with their
overall services, they will then be able to understand the program and ensure that
quality resources are allocated, modify the program and support it fully. This will
increase their returns on this investment.

The employers are held responsible for acceptable work environment and the impact
of the environment on the health and wellbeing of the workers. Challenges at work
environment such as air quality, noise pollution, overworking and work pressures
lead to sicknesses. Failure of the organization to plan for the prevention and
interventions of these could results in increased claims and litigations. Better
occupational health and safety services and medical services that help to identify job
related problems and reduce the exposure to risks are important services in an
organization. It is important that all staff members have access to preventative
occupational health services. This calls for services such as disease prevention
programs, health promotion programs and lifestyle related programs fitted into EWP.
The program can assist the staff members to realize the danger of poor health habits
and increase utilization of preventative services. Poor health habits may increase
absenteeism and reduce productivity. The organizations that maximize the wellbeing
of the staff members and manage corporate risk effectively will in turn improve and
face less challenges of this nature (Hillier, Fewell, Cann, & Sherphard, 2005:420).

It is the organization‟s responsibility to ensure that all employees‟ challenges are

taken care of. The organization must therefore develop the strategies to implement
wellness programs and ensure integration of well-being and wellness activities into
the responsibility of the organization. According to Hiltrop (1999: 424) the EWP can
be used to attract and keep the talented employees. This program must be well
developed to consider a holistic approach (Ginn & Henry, 2003: 25). The
organization that strives on improving the health of the workforce by implementing
the wellness program remains successful. Participants in the “Good for employee,
Good for business” study revealed that the employees perceived wellness program

8
as a good way to improve their overall health (Simpson, 2003: 122). When their
overall health improve, they become energetic, motivated and perform their duties
better. It is equally important for the organization to analyse and asses the utilization
of various components and the outcome by the component service delivered. Every
organization has its own work challenges, the leadership has to identify these
organizational challenges, which symptoms are presented and plan to overcome
them. Hillier, et al (2005: 419) cited out that integrated services would results with
reduction of the organizational symptoms such as labour turnover, labour relation
difficulties, poor quality control, and high rates of absenteeism. A wellness program
may assist in reduction of such symptoms. The improvement can be marked in areas
such as: fitness level, mood, health awareness, nutritional habits and health status of
the staff members (Hainess, Davis, Rancour, Robinson, Neel-Wilson & Wagner,
2007: 222). The „healthier‟ the workforce the better the performance –hence better
returns for the organization.

2.2 MAJOR WORK CHALLENGES, NECESSITATING

IMPLEMENTATION OF WELLNESS PROGRAM

The eligible age for formal employment is usually between 19-23 years of age. The
appointed staff members continue with their employment in organizations for a long
time until retirement at the age of 60-65 years. For the organization to address the
major work challenges effectively it is important to provide wellness program in a
comprehensive manner (Eaton, Marx & Bowie, 2006: 90). Every organization has
work pressure at a certain time. There are issues that are unavoidable in the work
environment, and these factors need to be identified and intervention planned for.
These factors calls for the employer to implement the wellness program while also
influence the staff members to seek help. If the organization has programs to
address challenges of stress, health of workers, counselling and HIV/AIDS testing
services in a planned manner, it will be able to relieve the workers from work
pressure (Journal compilation, 2007: 312). The work pressure may also results in
depression. Health institutions provide services to patients with terminal illness, for
e.g., patients with AIDS. According to Flaskured & Tabora (1997: 20) and UNAIDS
(2000: 5), health care workers providing care to these patients may suffer from
9
depression. The staff members need to utilize services like EWP to minimise such
pressure. Most organizations allow the EWP to function on voluntary basis. It has
been found however, that in those organizations where attendance to EWP is
voluntary, the staff members are not so keen to use the services (Rochowic, 1990). It
is up to the organizations to find innovative ways to encourage employees to
participate in these wellness programs. Major challenges at work that affect the staff
members results mainly from a particular organizational culture, work related stress
and organizational change. The organizations that implement EWP in a successful
manner are able to manage these major challenges better.

2.3 ORGANIZATIONAL STRESS

Stress is one of the most difficult challenges to be avoided at work. It may result with
staff members suffering from high blood pressures and back pains, leading to
chronic illnesses that may results in prolonged disability and sick leave. According to
Heymans, de Vet, Knol, Bongers, Koes & van Mechelen (2006: 686), if these factors
can be influenced and targeted by preventative or therapeutic treatments,
unnecessary hospitalisation and treatment will be prevented. EWP can also assist as
a cost effective intervention strategy in that absenteeism rate can be reduced while
staff earnings are also not affected by no work no pay, where applicable, thus
benefiting both the staff members and the organization. The staff members may
experience stress in both working and home environment, which tends to overlap
and result in impaired work productivity (Cunningham & Cookson, 2009: 19). The
staff members end up not enjoying their work, losing touch with their own need and
not taking care of themselves. Damage effects of the stress could increase spending
leading to financial strain, eating disorders affecting health, smoking that in the long
run contributes to increased claims and drinking leading to absenteeism. Excessive
pressure and increased demand of work lead to anxiety, lower performance, lower
energy, emotional exhaustion and poor sleep. All this results with negative effects on
the organization by low staff morale, low self esteem and low self confidence in their
work performance. On the other hand staff members who are not stressed may work
harder and become exhausted and similar adverse reactions may set in. Indecision
and low productivity become prominent and adversely affects the entire work force

10
(Hillier et al, 2005: 422), as the stressed groups are less productive, all the other
activities of the non stressed groups will be affected and there will be a gap in the
production. It is reported that work related stress cost United Kingdom employers
between 353 million pounds to 381 million pounds per year in 2005-2006 and cost
the society between 3.7 and 3.8 billion pounds while the number of work days lost
were doubled (Hillier et al, 2005: 422).

2.4 ORGANIZATION CULTURE

Culture refers broadly to set of beliefs, values and behaviour commonly held by the
society (Lim, 1995:16). Every organization has its own culture. The culture of the
organization has great effect on work life quality and employer–employee
relationship. According to Baron (1994: 11) organizations can have winning ways
with culture because culture is the way people think and act. People„s assumptions,
beliefs and value influence their behaviour. Culture is an integrated system of
learned pattern of behaviours, ideas and characteristics (Martin & Belcher (1986) in
Lynam (1992: 151) that can influence people‟s action and thinking. Therefore this
influence will be reflected in an organization. If the work environment does not
support the workers, services will be negatively affected. Some organizations
present with an „unhealthy‟ culture that exposes the staff members to bullying,
discrimination, drug addictions, abuse, dishonesty and absenteeism that undermine
the system performance (Hillier et al, 2005: 424). Having built the wellness program
into the corporate structure and ensure that EWP is part of the strategic plan the
organization will succeed in building a progressive culture, reduce health costs and
improve performance (Ginn & Henry, 2003: 25). It is crucial for the organization to
build the culture that encourages the staff members to feel at home whereby the
spirit of belonging and ownership results and compliment this with the
implementation of a comprehensive wellness program. The organization need to
ensure that the wellness program is communicated and popularized among the staff
members, policies are formalized and clearly understood, purpose and functions are
outlined to the staff members. The well established EWP built within the
organizational culture that uphold respect, love and compassion whereby the
aspects of confidentiality, secrecy and privacy are observed in all the procedure will

11
attract and serve as an encouragement to the staff members to continue utilizing the
services (Nofield, 2006).

2.5 ORGANIZATIONAL CHANGE

Work related changes affect the staff members and need to be effectively managed.
It is true that some staff members may suffer change phobias. Some staff members
may be poorly informed about change and become resistive. Management must
realise that people express psychological distress through their behaviours and
sometimes the behaviours become unproductive and increase tension instead of
reducing it (Burgess & Lazare, 1976: 210). If the staff members suffer from these
tension, productivity will be reduced, therefore well developed EWP is important.
Unhealthy organizational change may have adverse outcomes, especially if the
organization only concentrates on its own needs. If not effectively managed, change
can generate and sustain work related stress. The unfavourable changes in the work
environment might significantly contribute to unhealthy diet and sedentary behaviour
(Engbers, 2007: 10) which contributes to unhealthy work force, characterised by
disease of lifestyle like high blood pressure, diabetes and obesity. The change
process can be managed together with the employee wellness program. A clear
detailed program can be drawn and communicated to the staff members together
with EWP professionals who will assist the staff members to take the process of
change easy. Encouraging and allowing access to a well structured wellness
program can influence the staff members affected by the unfavourable change to
seek help and become able to understand the pro and cons of change. During
change it must be permissible for the staff members to develop and benefit from
change. EWP can assist the staff members to see change in a positive manner.

2.6 BENEFITS OF UTILIZATION OF THE EWP

The organizations that implemented effective wellness programs can attract most
skilled staff members. The staff members feel valued and welcomed. The staff
members may remain working for the organization for a long time only if they are
supported and see the organization as their home. Employees who access the
12
program could develop stress management skills, educate others on stress
management, life skills programs and develop knowledge on the resources to tap in
when in need of support. This will improve their wellbeing and loyalty to the
organization in the long run (Lim & Teo, 1996: 20). Coopers & Patterson (2007: 9)
cited out the benefits of implementing health wellbeing program in organizations as
leading to a win/win situation. The staff members who utilized the wellness program
benefit as the organization also benefit. The organization will benefit as the staff
members manage work effectively and production will be improved.

In their study on LIVE Model, Hillier et al (2005: 423) revealed that most employees
have been benefiting from using the wellness program especially in regard to alcohol
related problems. Alcohol abuse can lead to absenteeism and absenteeism reduce
work productivity and contribute to poor work performance. The organization service
delivery is jeopardized. The professional support the staff members are provided
with, within the EWP can benefit both the staff and the organization

Wellness programs can be used as a retention strategy. The health of the workforce
can be improved and staff members are likely to serve the organization for a long
time. A healthy workforce results with increased production (Lim & Teo, 1996: 22).
Keeping workers healthy may help the organization to reduce the health care costs,
improving morale and improving productivity. The employer must include areas
around risk assessment that will identify risks to the staff members‟ health, fitness
that reduce risk to illness, health education on the importance of ensuring healthy
living, management of illness and ensuring that the EWP staff implement the
program effectively and capacitate the staff members (Ginn & Henry, 2003: 25). It is
also important to the organization to market the wellness program to the staff
members and their family members. The strategy to market the program must also
include measures to ensure that the program is utilized by all the staff members
(Bubsbin & Campbell, 1990: 20), and having succeeded in marketing the decision
and ensuring the utilization thereof, on yearly basis the management must analyse
and assess the utilization rate of various components of the services and the
outcome thereof.

13
The organizations that emphasize general wellness programs and look at all
activities such as aerobic exercise programs, reduction of body weight and healthy
eating plans and ensured implementation thereof received better returns (Andrus &
Paul, 1995: 88 ). The staff members value these programs and as the programs are
paid for outside their own pocket by the organization they may be attracted to remain
in the organisation. They see the program as incentive and can serve the
organization for a long time. Liu, Martineau, Chen, Zhan & Tang (2006: 1837) state
that better use of incentives can improve the staff performance. If the EWP is well
Utilized it can assist the organization with better results. These organizations can be
able to retain talented staff members with enhanced personal health and improved
productivity (Simpson, 2003: 122). A productive worker is healthy, happy and free
from personal and work related problems.

In concluding, very few studies were conducted on utilization of the wellness

program. Most studies looked at the importance of using wellness program more
than the utilization rate of the various components. The paucity of literature in this
area demonstrated the relevance for this study.

14
 CHAPTER 3
METHODOLOGY

The methodology for this study was selected on the basis of its aims and objectives.
In this chapter, the study designs, the setting, population, tools and management as
well as ethical consideration are discussed.

3.1 STUDY DESIGN

A cross-sectional study was used for this study.

3.2 SETTING

The study was conducted in Natalspruit hospital, one of the Regional Hospitals in
Gauteng Province, in the employee wellness program section.

3.2.1 NATALSPRUIT HOSPITAL

Natalspruit Hospital is located in Ekurhuleni, Katlehong, Ward 52 and west of most

catchments areas it serves. Ekurhuleni has the population of 2. 899, 379 with 2.
269, 816 uninsured (Integrated Health planning Framework, 2004). Poverty,
unemployment and illiteracy are rife in this area and contribute to ill health and HIV
and AIDS epidemic. The hospital is a Level two hospital, providing both general and
specialized health care services with the bed capacity of 784 and bed occupancy
ranging between 79-80%.

15
 NATALSPRUIT
HOSPITAL

Figure 3.1 Location of Natalspruit Hospital

3.2.2 THE HOSPITAL STAFF ESTABLISHMENT

The total staff establishment was 1817 with a total of 1409 post filled including the
additional posts off the internship doctors and nurses as well as the retired nurses.
The hospital staff establishment is categorised on the table below:

16
Table 3.1 The hospital staff establishment categories

CATEGORY APPROVED FILLED VACANT % OF % OF

POSTS POSTS POSTS VACANCY FILLED
POSTS POSTS
MEDICAL 117 105 12 10 90
PROFESSIONALS

MEDICAL INTERNS 33 33 100

(additional not
counted in the
establishment)
MEDICAL 26 26 - - 100
SESSIONS (additional not
counted in the
establishment)
NURSING 833 706 122 15 85
PERSONNEL
RETIRED NURSES 6 6 - - 6
(additional not
counted in the
establishment)
ALLIED 77 57 20 26 74
PROFESSIONALS
ADMINISTRATION 282 154 128 45 55
STAFF
SUPPORT STAFF 508 387 121 24 76

TOTAL 1817 1409 408 22 78

3.3 SCOPE OF THE STUDY

This study involved a retrospective review of EWP records over a period of 1 year,
from January to December 2009.

3.4 STUDY POPULATION

Study population includes all the staff members of Natalspruit Hospital who utilized
the wellness program during 2009.

17
3.5 STUDY SAMPLE

All the records of the staff members who utilized the wellness program services in
any of the five components were reviewed.

3.6 PILOT STUDY

The study was piloted reviewing one month‟s records of the staff members who
utilized the wellness program at Natalspruit hospital during November 2008. Total
number of staff members at that time was 1329 and total 59 records of those visited
EWP were evaluated. The pilot study helped to assess the accuracy of the data
instruments and enabled the researcher to refine the instruments.

3.7 DATA MANAGEMENT

3.7.1 INSTRUMENT

Data Collection Tools that were used for each objective were designed for this study
based on MS Excel and attached as Appendix D. This tool has been validated and
used in one of the regional hospital in Gauteng Province.

3.7.2 DATA COLLECTION

The study used data that were routinely collected by the wellness program staff
members (Table 3.2). Data was collected by the researcher only to ensure
confidentiality. Each component of the wellness program was allocated a specific
code. The Information and conclusions were drawn from the records: Wellness
program register and staff members‟ files.

18
Table 3.2 Source of data
Objectives Study Instruments Source
1 Tool 1 Wellness program register
2 Tool 2 Wellness program register
3 and 4 Tool 3 EWP staff members files

3.7.3 DATA ANALYSIS

Data was captured on to the excel spreadsheet. The data was cleaned to identify
and isolate any missing data and error in recording and scrutinised for any potential
errors (Gerrish & Lacey, 2006: 439) and then analysed with EPI-Info software
version 3.4.1. Each component of wellness program was allocated specific code for
easy analysis and interpretation. The data analysis was done by the researcher only.
Data was categorised into distinct groups of nurses, medical officers, allied,
administration staff and support staff. The data was then aggregated to make it
impossible to identify the age, occupation and profession of a particular individual.
Lastly data was organised, summarised, described and presented (Newell &
Burnard, 2006: 190; Knapp, 1985: 10; Polit & Hunglar, 2001: 330).

3.7.4 STATISTICAL TESTS

Descriptive statistics following continuous variables with normal distribution: Mean

and standard deviation were used. Confidence level of 95% was calculated as the
statistical significance. Chi square and p-value were determined. Lastly data was
captured onto a personal computer.

3.8 ETHICAL CONSIDERATION

A written request was approved by the hospital and Gauteng Department of Health
(Appendix C) for permission to analyze the records of the staff members who

19
attended the wellness program in the last year at Natalspruit Hospital. All the
processes were considered after the University had awarded the ethical clearance
certification (Ethics certificate number: M10254) (Appendix A). The researcher had
access to the hospital register and staff members‟ files via an intermediary.
Confidentiality and anonymity was ensured. Data collection and analysis was done
by the researcher only. During data analysis data was aggregated to make it
impossible to identify the age, occupation and profession of a particular individual.

20
 CHAPTER 4
RESULTS

The results obtained from the analysis of data are described in this chapter.

4.1 RESPONSE

Data was collected from the EWP attendants register, verified and compared to the
available files. A total of 985 entries were found, 941 were found relatively complete
and the study results are based on that. A total of 44 entries were not used on
reasons that some were incomplete, with missing age, sex and or reason for the visit
while others were for the family members that are excluded in this study.

4.2 STAFF ATTENDANCE

Almost 80.1% of the staff members are recorded to have attended the EWP during
2009, with at least 5.8% attendance on monthly basis. The staff attendance at the
staff wellness program during the study period is listed in the Table 4.1 and further
presented on Figure 4.1. The average attendance was 80.1% (SD 22.1) indicating
that the total number of visits represents 80% of the total staff complement and that
actual utilization per staff member is much lower as indicated on monthly basis on
Table 4.1 below. Most staff members repeated the visit for continuation of services
such as in for birth control area for family planning.

21
Table 4.1 Proportion of staff members who attended EWP clinic
Total Staff Attendance
JAN 1394 54 (3.9%)
FEB 1366 66 (4.8%)
MARCH 1361 79 (5.8%)
APRIL 1363 59 (4.3%)
MAY 1372 62 (4.5%)
JUNE 1371 93 (6.8%)
JULY 1395 78 (5.6%)
AUGUST 1391 82 (5.9%)
SEPTEMBER 1390 118 (8.5%)
OCTOBER 1388 93 (6.7%)
NOVEMBER 1378 119 (8.6%)
DECEMBER 1456 59 (4.1%)
TOTAL ATTENDANCE 941 (80.1%)

2000

1800

1600

1400

1200
Staff establishment
1000
Filled posts
800
EWP attendance
600

400

200

0
EWP Atendance

Figure 4.1 Staff Attendance at the wellness clinic for the year 2009 as
compared with the staff establishment and the total posts filled

22
4.3 DEMOGRAPHIC PROFILE

4.3.1 AGE

The median age of the subjects were 39 years (Inter-quartile range: 33- 46).
Minimum age of the staff was 19 while the maximum was 63. The median age for
females and males were 39 and 42 years respectively. The males in this group were
significantly older than females (Mann Whitney‟s test, p<0.01). The age and gender
distribution of attendees are illustrated in Table 4.2.

4.3.2 GENDER

Out of the total of used records, 850 females utilized the services in comparison to
91 males in the period under study. Most of these women were at the child bearing
age.

Table 4.2 Age and gender of the subjects (n= 941)

Total (n = 941 ) Female (n = 850) Male (n= 91)
Age 39 (33-46) 38 (32-45) 42 (33-49)

4.4 OCCUPATION

Table 4.3 and Figure 4.2 summarize the occupation of the subjects. Administration
staff members utilization of the services equalled 119 (12.6%), Allied 90 (9.6%),
Medical section 26 (2.8%), Nursing 533 (56.7%), Public works 2 (0.2%), Support 170
(18.1%) (Figure 4.2). Of the total of those who used the services 56% of the staff
members are from the nursing occupation. They are the occupation that utilized the
services more than any other occupational category.

23
Table 4.3 Occupation of the subjects (n= 941)
Total (n = 941) Female (n = 850) Male (n= 91)
Administration 119 (12.6%) 102 (12.0%) 17 (18.7%)
Allied 90 (9.6%) 83 (9.8%) 7 (7.7%)
Medicine 26 (2.8%) 21 (2.5%) 5 (2.8%)
Nursing 533 (56.7%) 492 (57.9%) 42 (46.2%)
Public works 2 (0.2%) 1 (0.1%) 1 (1.1%)
Support 170 (18.1%) 15 (17.8%) 19 (20.9%)
Total 941 (100%) 850 (100%) 91 (100%)

60%

50%
Adminstration
40% Allied
30% Medicine
Nursing
20%
Public works
10% support
0%
Females Males Total

Figure 4.2 Occupations of the subjects

4.5 WORK SECTION OF THE SUBJECTS

Table 4.4 and Figure 4.3 give the indications of the working section of the staff
members who utilized the wellness clinic. Cleaning Section 106 (11.3%), ECG
Department 1 (0.1%), Kitchen 36 (3.8%), Laboratory 16 (1.7%), Linen room 2
(0.2%), Out Patient Department 139 (14.8%), Pharmacy 19 (2.0%), Physiotherapy
Department 7 (0.7%), Porter‟s office 6 (0.6%), Social worker‟s Department 3 (0.3%),
Security Section 23 (2.4%), Speech therapy Department 5 (0.5%), Switchboard 2
(0.2%), Wards 56 (59.5%), Workshop 2 (0.2%), X-Ray Department 14 (1.5%). Most
staff members who visited the wellness clinic were working in the wards.

24
Table 4.4 Work section of the subjects (n= 941)
Total (n = 941 ) Female (n = 850) Male (n= 91)
Cleaning Section 106 (11.3%) 89 (10.5%) 17 (18.7%)
ECG Department 1 (0.1%) 1 (0.1%) 0 (0.0%)
Kitchen 36 (3.8%) 36 (4.2%) 0 (0.0%)
Laboratory 16 (1.7%) 15 (1.8%) 1 (1.1%)
Linen room 2 (0.2%) 2 (0.2%) 0 (0.0%)
Out Patient 139 (14.8%) 123 (14.5%) 16 (17.6%)
Department
Pharmacy 19 (2.0%) 18 (2.1%) 1 (1.1%)
Physiotherapy 7 (0.7%) 4 (0.5%) 3 (3.3%)
Department
Porter‟s office 6 (0.6%) 4 (0.5%) 2 (2.2%)
Social worker‟s 3 (0.3%) 3 (0.4%) 0 (0.0%)
Department
Security Section 23 (2.4%) 23 (2.7%) 0 (0.0%)
Speech therapy 5 (0.5%) 5 (0.6%) 0 (0.0%)
Department
Switchboard 2 (0.2%) 1 (0.1%) 1 (1.1%)
Wards 56 (59.5%) 513 (60.4%) 47 (51.6%)
Workshop 2 (0.2%) 1 (0.1%) 1 (1.1%)
X-Ray Department 14 (1.5%) 12 (1.4%) 2 (2.2%)
Total 941 (100%) 850 (100%) 91 (100%)

25
 Figure 4.3 Work sections of the subjects

4.6 PROFESSION OF THE SUBJECTS

Table 4.5 below summarizes the profession of the subjects. Out of the total of 941
more than half of the staff members were from the nursing profession 534 (56.7%)
followed by the Clerks 113 (12.0 %).

26
Table 4.5 Profession of the subjects (n= 941)
Total (n = 941 ) Female (n = 850) Male (n= 91)
MEDICAL 26 (2.8%) 21 (2.5 %) 5 (5.5 %)
NURSING 534 (56.7%) 492 (57.9%) 42 (46.2 %)
ALLIED
Pharmacy assistants 19 (2.0%) 18 (1.1 %) 1 (2.0 %)
Counsellors 22 (2.3 %) 22 (2.6 %) 0 (0.0 %)
Dietician 3 (0.3 %) 3 (0.4 %) 0 (0.0 %)
ECG technician 1 (0.1 %) 1 (0.1 %) 0 (0.0 %)
Laboratory assistants 16 (1.7 %) 15 (1.8 %) 1 (1.1 %)
Physiotherapy assistant 2 (0.2 %) 0 (0.0 %) 2 (2.2 %)
Physiotherapist 5 (0.5 %) 4 (0.5 %) 1 (1.1 %)
Radiographer 12 (1.3 %) 12 (1.4 %) 0 (0.0 %)
Social worker 3 (0.3 %) 3 (0.4 %) 0 (0.0 %)
Speech therapy assistant 2 (0.2 %) 2 (0.2 %) 0 (0.0 %)
Speech therapist 3 (0.3 %) 3 (0.4 %) 0 (0.0 %)
X – Ray assistant 2 (0.2 %) 0 (0.0 %) 2 (2.2 %)
ADMINISTRATION
Clerk 113 (12.0 %) 97 (11.4 %) 16 (17.6 %)
Data capturer 2 (0.2 %) 2 (0.2 %) 0 (0.0 %)
Switchboard operator 2 (0.2 %) 1 (0.1 %) 1 (1.1 %)
Queue marshal 2 (0.2 %) 2 (0.2 %) 0 (0.0 %)
SUPPORT
Cleaner 106 (11.3 %) 89 (10.5 %) 17 (18.7 %)
Food aid 33 (3.5 %) 33 (3.9 %) 0 (0.0 %)
Porter 6 (0.6 %) 4 (0.5 %) 2 (2.2 %)
Public worker 1 (0.2 %) 0 (0.0 %) 1 (1.1 %)
Security officer 23 (2.4 %) 23 (2.7 %) 0 (0.0 %)
Linen aid 2 (0.2 %) 2 (0.2 %) 0 (0.0 %)
TOTAL 941 (100 %) 850 (100 %) 91 (100 %)

27
4.7 TYPE OF VISIT TO THE CLINIC

Table 4.6 and Figure 4.4 present the type of visits to the clinic. This indicates that
most staff members were continuing with the services from the previous year. Initial
visits were 73 (7.8%) while those on ongoing visits were 868 (92.2%).

Table 4.6 Type of visit to the clinic (n= 941)

Total (n = 941 ) Female (n = 850) Male (n= 91)
Initial 73 (7.8%) 64 (7.5%) 9 (9.9%)
Ongoing 868 (92.2%) 786 (92.5%) 82 (90.1%)
Total 941 (100%) 850 (100%) 91 (100%)

100.00%

80.00%

60.00% Total
Females
40.00%
Males
20.00%

0.00%
Initial Ongoing

Figure 4.4 Type of the visit

4.8 COMPONENT ATTENDED

Table 4.7 as well as Figure 4.5 present the components attended in terms of the
areas the services was sought for. Birth Control services (BC) were highly utilized
460 (48.9 %). Other components attended as follows: Family problems finance (FPF)
3 (0.3 %), Human Immune Virus (HIV) 92 (9.8 %), Health Related (HR) 112 (11.9
%), Occupational Health & Safety (OHS) 164 (17.4 %), Others (OT) 74 (7.9 %) and
Psychosocial (PSY) 36 (3.8 %).

28
Table 4.7 Component attended (n= 941)
Component Total (n = 941 ) Female (n = 850) Male (n= 91)
Birth control (BC) 460 (48.9 %) 452 (53.2 %) 8 (8.8 %)
Family problems 3 (0.3 %) 1 (0.1 %) 2 (2.2 %)
finance (FPF)
Human Immune 92 (9.8 %) 75 (8.8 %) 17 (18.7 %)
Virus (HIV)
Health Related 112 (11.9 %) 97 (11.4 %) 15 (16.5 %)
(HR)
Occupational 164 (17.4 %) 140 (16.5 %) 24 (26.4 %)
Health & Safety
(OHS)
Others (OT) 74 (7.9 %) 58 (6.8 %) 16 (17.6 %)
Psychosocial(PSY) 36 (3.8 %) 27 (3.2 %) 9 (9.9 %)
Total 941 (100 %) 850 (100 %) 91 (100 %)

60.00%
50.00%
40.00%
30.00% Males
Females
20.00%
10.00%
0.00%
BC FPF HIV HR OHS OT PSY

Figure 4.5 Component attended

29
4.9 PROFESSION AND COMPONENT ATTENDED

In Table 4.8 and Figure 4.6 the professions and components attended are
presented. Nursing (53%) is the profession that attended birth control services in
majority. Majority of medical officers attended occupational health and safety
services (50%) mostly. Allied staff members (55.6%) and administration staff
members (56.3%) mostly attended birth control services. The support staff (31, 2%)
sought the health related services while public works workers sought services in both
HIV and Birth control equally (50.0%). There was significant association between
occupational category and component used (Chi-square test, p<0.001)

Table 4.8 Profession and Component attended (n= 941)

Component Occupational category
Total Admin Allied Medicine Nursing Public Support
works
Birth control 460 67 50 9 286 1 50
(BC) (48.9%) (56.3%) (55.6%) (34.6%) (53.0%) (50.0%) (29.4%)
Family 3 0 1 0 1 0 1
problems (0.3%) (0.0%) (1.1%) (0.0%) (0.2%) (0.0%) (0.6%)
finance (FPF)
Human 92 7 8 4 44 1 28
Immune (9.8%) (5.9%) (8.9%) (15.4%) (8.2%) (50.0%) (16.5%)
Virus (HIV)
Health 112 24 11 0 24 0 53
Related (HR) (11.9%) (20.2%) (12.2%) (0.0%) (4.5%) (0.0%) (31.2%)
Occupational 164 6 6 13 132 0 7
Health & (17.4%) (5.0%) (6.7%) (50.0%) (24.7%) (0.0%) (4.1%)
Safety (OHS)
Others (OT) 74 8 11 0 31 0 24
(7.9%) (6.7%) (12.2%) (0.0%) (5.8%) (0.0%) (14.1%)
Psychosocial 36 7 3 0 19 0 7
(PSY) (3.8%) (5.9%) (3.3%) (0.0%) (3.9%) (0.0%) (4.1%)
Total 941 119 90 26 534 2 170
(100%) (100%) (100%) (100%) (100%) (100%) (100%)

30
 60.00%

50.00% Admin
Allied
40.00% Medicine
Nursing
30.00% Public W
Support
20.00%

10.00%

0.00%
BC FPF HIV HR OHS OT PSY

Figure 4.6 Profession and component attended

4.10 REASONS FOR VISIT TO THE CLINIC

In Table 4.9 and Figure 4.7 the reasons for which the staff members visited the clinic
are indicated. The staff members visited the clinics for the following reasons: Abuse
(A) 1 (2.8%), Adherence (Ad) 26 (7.7%), Blood pressure (BP) 72 (1.8%), Cell count
(CD4) 17 (1.8%); Diabetic Mellitus (DM) 26 (2.8%); Finance (FIN) 3 (0.3%), Family
Planning (FP) 458 (48.7%); Hepatitis B (HPB) 198 (11.5%); Injury (INJ) 12 (1.3%),
Mental (MEN) 28 (3.0%); Needle prick (NP) 37 (3.9%); Other Health Problems (OH),
87 (9.2%) Flu vaccine (U) 6 (0.6); Voluntary testing & counselling (VCT) 47 (5.0%);
Work health Problem (WHT) 1 (0.1%) and Work Related (WR) 12 (1.3%). Family
planning services were highly utilized.

31
Table 4.9 Reasons for visit to the clinic (n= 941)
Total (n = 941 ) Female (n = 850) Male (n= 91)
Abuse (A) 1 (2.8%) 1 (0.1%) 0 (0.0%)

Adherence (Ad) 26 (7.7%) 15 (1.8%) 11 (12.1%)

Blood pressure (BP) 72 (1.8%) 62 (7.3%) 10 (11.0%)

Cell count(CD4) 17 (1.8%) 15 (1.8%) 2 (2.2%)

Diabetic 26 (2.8%) 21 (2.5%) 5 (5.5%)

Mellitus(DM)
Finance (FIN) 3 (0.3%) 1 (0.1%) 2 (2.2%)

Family Planning(FP) 458 (48.7%) 450 (52.9%) 8 (8.8%)

Hepatitis (HPB) 198 (11.5%) 96 (11.3%) 12 (13.2%)

Injury(INJ) 12 (1.3%) 11 (1.3%) 1 (1.1%)

Mental(MEN) 28 (3.0%) 21 (2.5%) 7 (7.7%)

Needle prick(NP) 37 (3.9%) 28 (3.3%) 9 (9.9%)

Other Health 87 (9.2%) 73 (8.6%) 14 (15.4%)

Problems (OH)
Flu Vaccines(U) 6 (0.6) 6 (0.7%) 0 (0.0%)

Voluntary testing & 47 (5.0%) 43 (5.1%) 4 (4.4%)

counselling (VCT)
Work health 1 (0.1%) 0 (0.0%) 1 (1.1%)
Problem (WHT)
Work Related (WR) 12 (1.3%) 7 (0.8%) 5 (5.5%)

Total 941 (100%) 850 (100%) 91 (100%)

32
 Abuse (A)
50.00% Adherence (Ad)

45.00% Blood pressure (BP)

40.00% Cell count(CD4)

Diabetic Mellitus(DM)
35.00% Finance (FIN)
30.00% Family Planning(FP)

25.00% Hepatitis (HPB)

20.00% Injury(INJ)

Mental(MEN)
15.00% Needle prick(NP)
10.00% Other H Prob (OH)

5.00% Flu Vacc (U)

Voluntory CT
0.00%
Work H prob (WHT)

Work rel (WR)

Figure 4.7 Reasons for visit to the clinic (n= 941)

4.11 PROFESSION AND REASONS FOR VISIT

Table 4.10 gives the summary of the profession and reasons for the visit to the clinic.
Administration clerks staff members mostly visited for family planning (57.1) and
blood pressure control (16.0%); the majority of the allied staff members visited for
family planning and other health related problems; most medical officers (42.3%)
visited for needle prick while (34.6% ) visited for family planning; nursing staff mostly
attended for family planning services ( 52.4%) and hepatitis B (18.5%) and Public
works staff members visited for both family planning and HIV/AIDS adherence
equally (50.0%). The support staff members, cleaners visited mostly for family
planning (30.0%) and high blood pressure (18.2%). There are significant differences
in reasons for visit among the different occupational groups (chi-square test,
p<0.0001).

33
Table 4.10 Profession and reasons for visit (n= 941)
Reason for Admin Allied Medicine Nursing Public Support Total
visit works
Abuse 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (0.2%) 0 (0.0%) 0 (0.0%) 1 (0.1%)
Adherence 2 (1.7%) 0 (0.0%) 0 (0.0%) 14 (2.6%) 1 9 (5.3%) 26 (2.8%)
to (50.0%)
Treatment
(Ad)
Blood 19 (16.0%) 6 (6.7%) 0 (0.0%) 16 (3.0%) 0 (0.0%) 31 (18.2%) 72 (7.7%)
pressure
(BP)
Cell count 2 (1.7%) 1 (1.1%) 0 (0.0%) 5 (0.9%) 0 (0.0%) 9 (5.3%) 17 (1.8%)
(CD4)
Diabetic 4 (3.4%) 2 (2.2%) 0 (0.0%) 4 (0.7%) 0 (0.0%) 16 (9.4%) 26 (2.8%)
Mellitus
(DM)
Finance 0 (0.0%) 1 (1.1%) 0 (0.0%) 1 (0.2%) 0 (0.0%) 1 (0.6%) 3 (0.3%)
(FIN)
Family 68 (57.1%) 49 (54.4%) 9 (34.6%) 280 1 51 (30.0%) 457
Planning (52.4%) (50.0%) (48.7%)
(FP)
Hepatitis 2 (1.7%) 6 (6.7%) 1 (3.8%) 99 (18.5%) 0 (0.0%) 0 (0.0%) 108
(HPB) (11.5%)
Injury(INJ) 3 (2.5%) 0 (0.0%) 0 (0.0%) 8 (1.5%) 0 (0.0%) 1 (0.6%) 12
(1.3%)
Mental 6 (5.0%) 3 (3.3%) 0 (0.0%) 16 (3.0%) 0 (0.0%) 3 (1.8%) 28 (3%)
(MEN)
Needle 0 (0.0%) 0 (0.0%) 11 24 (4.5%) 0 (0.0%) 2 (1.2%) 37 (3.9%)
prick(NP) (42.3%)
Other 8 (6.7%) 13 (14.4%) 1 (3.8%) 37 (6.9%) 0 (0.0%) 28 (16.5%) 87 (9.2%)
Health
Problems
(OH)
Flu vaccine 0 (0.0%) 1 (1.1%) 0 (0.0%) 3 (0.6%) 0 (0.0%) 2 (1.2%) 6 (0.6%)
(U)
Voluntary 3 (2.5%) 7 (7.8%) 4 (15.4%) 23 (4.3%) 0 (0.0%) 10 (5.9%) 47 (5%)
testing &
counselling
(VCT)
Work health 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (0.2%) 0 (0.0%) 0 (0.0%) 1 (0.1%)
Problem
(WHT)
Work 2 (1.7%) 1 (1.1%) 0 (0.0%) 2 (0.4%) 0 (0.0%) 7 (4.1%) 12 (0.3%)
Related
(WR)
Total 119 (100%) 90 26 534 (100%) 2 170 (100%) 941
(100%) (100%) (100%) (100%)

34
4.12 OUTCOME OF VISIT TO THE CLINIC

The Table 4.11 and Figure 4. 8 present the outcome of the visits to the clinic. Most
staff members‟ service intervention outcome required that they come back (86.8%),
some few referred to internal outpatient department / casualty (4.9%) and (0.3%) to
ICAS while (0.1%) referred to court. Only (7.8 %) were resolved in the clinic. There
was significant differences between male and female staff in terms of the outcomes
of their visits (Chi-square test, p<0.01).

Table 4.11 Outcome of visit to the clinic (n= 941)

Outcome Total (n = 941 ) Female (n = 850) Male (n= 91)

Unresolved(Cont) 818 (86.9 %) 740 (87.1 %) 78 (85.7 %)

Resolved(R) 73 (7.8%) 68 (8.0%) 5 (5.5 %)
Referred to 46 (4.9 %) 40 (4.7%) 6 (6.6 %)
OPD/Casualty(RE)
Ref erred to ICAS( 3 (0.3%) 2 (0.2%) 1 (1.1 %)
Re ICAS)
Referred to court 1 (0.1%) 0 (0.0%) 1 (1.1%)
(RE)
Total 941 (100%) 850 (100%) 91 (100 %)

90.00%
80.00%
70.00%
60.00%
50.00% Total
40.00% Females
30.00% Males
20.00%
10.00%
0.00%
Unresolved Resolved Ref OPD/Cas Ref ICAS Ref Court

Figure 4.8 Outcome of the visit to the clinic

35
4.13 OUTCOME OF THE SERVICE ACCORDING TO THE
SERVICES ATTENDED

Outcome of the services according to the section attended are described in Table
4.12 and Figure 4.9. Most of the Birth control (458/460, 99%) users continued with
the service. Cases that were referred to OPD/Casualty were high among the „Other
Related services‟ such as back pains or just pains (35/74, 47%). Only (2/36, 0.7%)
of Psychosocial cases were resolved, Occupational and Health and Safety (24/164,
32, 9%) cases were resolved while few were referred to ICAS, Family problems for
finance (1) case was referred to court. There was a significant association between
component attended and outcome of services (Chi-square test p<0.001).

Table 4.12 Outcome of the services according to the section attended

COMPONENT OUTCOME BY THE SERVICES
ATTENDED
Total Unresolved/ Resolved Referred Referred referred
Continue to Cas/ to ICAS to court
OPD
Birth control 460 458 2 0 0 0

(BC) (48.9% (56%) (2.7%)

Family problems 3 2 0 0 0 1
finance (FPF) (0.3%) (0.2) (0.1%)

Human Immune 92 61 30 1 0 0

Virus (HIV) (9.8%) (7.5%) (41.1%) (2.2%)

Health Related 112 101 4 7 0 0

(HR) (11.9%) (12.3%) (5.5%) (15.2%)

Occupational 164 136 24 3 1 0

Health & Safety (17.4%) (16.6%) (32.9%) (6.5%) (33.3%)

(OHS)
Others (OT) 74 28 11 35 0 0
(7.9%) (3.4%) (15.1%) (76.1%)
Psychosocial 36 32 2 0 2 0
(PSY) (3.8%) (3.9%) (0.7%) (66.7%)

Total 941 818 73 46 3 1

(100%) (100%) (100%) (100%) (100%) (100%)

36
 80%
Ref ICAS
70%
60%
Birth control
Resolved 50% Family problems
finance (FPF)
Human Immune
40% Virus (HIV)
Health Related (HR)
30% Occupational Health
Unresolved & Safety (OHS)
Others
20%
Ref Court Pyscosocial (PSY)
10%
0%
Ref Cas/OPD

Figure 4.9 Outcome of the services according to the section attended

37
 CHAPTER 5
DISCUSSION

In this chapter the results obtained from the analysis of data are discussed and
compared with those from published studies.

5.1 INTRODUCTION

The study determined the proportion of the staff members that utilized the EWP
during the study period. This was the first research since the Gauteng Department of
Health introduced the program; therefore the bulk of the literature review was only
available in some official documents and reports of the department and hospital. The
documents reviewed were selected after considering the content and the relevancy
to the topic. The findings documented in this report are based on the recorded
information by the staff members working in the EWP.

5.2 CLINIC ATTENDANCE

Clinic attendance is based on the Department of health policy, program package and
the fact that the program can only be accessed during normal week days; Monday-
Friday. All the staff members are at liberty to visit the clinic for the services they
desire. Attendance is recorded on the register and the staff members‟ personal files.
Staff members attended the clinic were also given the clinic cards to remind them on
when to come back if need be. At each visit they were recorded until the file is closed
when sessions were completed. Any staff member and members of their family are
free to attend the clinic; however this study excluded the family members.

Month to month clinic attendance was noted to be just above 5.8% and consistently
less than 10% on every month. This indicates that the monthly utilization rate is
worryingly low. However at the end of the year there were almost 985 (80.1%)
recorded to have been seen in the clinic. These figures represent the proportion of
visits per total staff complement. It does not take into account the multiple visits of
each staff member. The study did not asses the number of repeat visits, but only the
38
number of actual visits. This figure thus over represents the utilization of the service.
Most of these staff members who attended the clinic were nurses working in the
wards. The staff members who works in the ward are most of the time with the sick
patients with different illness; they need to be sensitive to the need of these patients;
according to Leininger (1988: 156) it is rather important that the nurses be part of the
organization that is sensitive so that they can be able to provide culturally sensitive
care (Lynam, 1992: 151), considering that they provide care to patients who might be
dying even at an early stage of life. The times that the service is functional should be
re-looked at. Is it open at a time that may not be convenient for most workers – e.g.
those who work shifts? It is of crucial importance for the organisation to encourage
these nurses to attend the EWP.

5.3 PROFILE OF SUBJECTS

The demographic profile of the subjects considered the entire work population and at
the end of the year under study the overall employee demographics consisted of
1409 staff members appointed, of which 50% were nurses, 27% support staff, 12%
medical officers, 11% administration staff and 4% allied staff members. The
indicators used were: age, gender, occupation, work section and profession.

5.3.1 DEMOGRAPHIC PROFILE

Age

The results revealed that the majority of the staff members attended the services
were between the age of 33-46. Most of them were woman between the age of 32-
45 (850/90%). Of the 90% woman who attended the clinic, most of them were at the
child bearing age and sought the birth control services in family planning.

Males were between the age ranges of (32-49) with 42 as the median. Only 10% of
the staff members who attended the clinic were men and sought the services in
different areas including family planning. Most of these males were nurses and
worked in the wards.

39
Gender

The majority of the staff members who attended the clinic were the women. Most
women and couples believe that the best birth control methods are when the women
attend the family planning. Most men depend on the women to participate in female
birth control methods; however few men 8% attended the family planning services.

5.3.2 PROFESSIONAL AND OCCUPATIONAL PROFILE

Professional profile of the attendants almost covered all the occupational categories
as all the workers had equal access to the services. The majority of the staff
members that mostly utilized the services were from the nursing profession (56.7%)
one may link this to the demands that the nursing profession has; that of providing
care to the sick for 24 hours. It must be acknowledged that in the health care service
provision the majority of the staff members are nurses. The nurses in the general
wards provide nursing care to people with different health problems and the admitted
people are almost very ill. With HIV/AIDS epidemic even those that are not
diagnosed yet may be infected (Manamela, 2006: 171) and the nurses need to be
supported through the utilization of the EWP in order to cope in providing care to all
the patients as if they are HIV/AIDS infected. Therefore the nurses realised the
importance of well-being even at work. It is also important for the organizations to
take seriously the need for the professional support (Scanlon & Weir, 1997: 295) of
these nurses. Therefore one of the components for the EWP must be profession
orientation. The support staff members were the second in majority to attend the
services (18.1%), followed by the administration staff, the importance of the services
to all other groups needs to be emphasised. On the last, were the allied and medical
officers followed by the public works workers. The fact that there are few staff
members in other professions and occupations cannot be ignored.

5.3.3 WORK PROFILE

The environment where the staff members work has an influence on the utilization of
the services. Some work requirement exposed the staff members to danger that

40
need to be prevented, for example in nursing profession all newly appointees who
will be in contact with the patients in the wards must be given hepatitis B. Contact
with some human serum and blood also pose a danger and the department made it
possible for the staff to be assisted immediately. Therefore most staff members who
work in these areas are more likely to attend the clinic than those who are not. From
time to time the staff members in the nursing and medical work environment prick
themselves with needles during the procedures, or there is blood flush on to their
faces during the operations and they have to be supported to minimise the risk of
infections. However EWP is designed to assist, support and advise all employees
who experience personal and or job related problems.

5.4 COMPONENTS UTILIZED

Various components were utilized and the findings indicated that the majority of the
staff members visited the clinic to seek the services in the organization and climate
for management of health related problems, especially in the services of birth control
for family planning section. It seems a waste of resources to have an entire wellness
program where staff members are mostly using it primarily for family planning.
Occupational Health and Safety components was rated second especially for needle
prick and hepatitis B, followed by the staff member who sought services in health
related components that covers chronic illness such as high blood pressure and
diabetes mellitus; HIV/AIDS services for adherence and voluntary counselling and
testing were fairly utilised. In general the three most components utilized were:
HIV/AIDS workplace employee assistance program, occupational health and safety
program, organization and climate for management of health related problems while
other components such as psychosocial program that address aspects of substance
abuse, trauma, stress, organizational tension, dynamics of family matters, money
problem, depression and any other psychosocial/health problems affecting the staff
members at work were less utilized. It is therefore important that there be a
comprehensive EWP model that meet the requirements as listed in figure 4.10
below:

41
 Requirements for effective Employee Wellness program

Capacity for effective Viable strategic Implementation

policy management strategy

policy

Responsible & Organization

accountable policy relevant/culture
Orientated staff on
making authority components
utilization

Monitoring & Effective budget & Associated work

Evaluation strategy other resources Risks

Figure 5.1 Requirements for effective Employee Wellness Program

For any policy to be effective there should be commitment by the policy making
authority. It is equally important in the utilization of the EWP for the authorities to
take the lead and ensure effective and efficient implementation. In this study the
majority of the staff utilized the organization and climate for management of health
related problems, especially in the services of birth control for family planning
section. It seems a waste of resources to have an entire wellness program where
42
staff members are mostly using it primarily for family planning. It appears that the
hospital management were not taking the EWP as one of the deliverable seriously.
Therefore it become evident in that the “Requirements for effective Employee
Wellness Program” model be considered; the authorities must take the responsibility
and accountability and lead in every area by ensuring that there is a viable strategic
policy; develop, monitor and evaluate the implementation strategy. And also to
ensure that the appointed staff members are skilled and capacitated for effective
policy implementation and management; these staff members in the EWP must be
able to understand the importance of the staff members‟ perspective and social
context and incorporate that within the services needed (Lynam, 1992: 152); of the
most important is the consideration of organization relevant/culture components,
which must also be cultural sensitive (Leininger, 1988: 153). Management must
endeavour to market the strategy and orientate the staff members on utilization. The
program managers should evaluate their current communication strategy to asses if
they are reaching out to all employees, educating them about the availability and
accessibility of the service. Providing information to the staff members is the
cornerstone of the EWP.

The EWP section should have effective budget and other necessary resources. The
budget for the wellness program should be evaluated to establish if all the resources
are available when required. If for example certain drugs or equipments are not
available on a regular basis, employees might lose faith and not attend. It will also be
naive for the management to ignore the risk associated with the work the staff
members has to perform. These requirements are important for the EWP to yield
better benefit for the organization and the staff members.

5.5 OUTCOME BY THE SERVICES

5.5.1 UNRESOLVED/ CONTINUATION

Almost 86.6 % of the staff members seen in the clinic were to continue with the
services, especially in the area of birth control as this is usually a continuous process
until the women reach the menopause state or decided to become pregnant.

43
The staff members who attended the occupational health and safety services are
also expected to continue, especially for hepatitis B that should be repeated for three
times. The medical profession (42.3%) sought the services for the needle pricks.
These staff members had to do HIV test, then follow up will be made after the
completion of the treatment. Therefore the attendees for these services had also to
continue visiting the clinic for at least two to three times –hence the increase number
of those who continues with the treatment.

5.5.2 RESOLVED CASES

Only 7 .8 % of the staff members attended the clinic had their problems resolved.
Majority of the staff members were in the nursing profession. The clinic however is a
continuous service but for the different needs of the staff. Therefore it is expected
that their problems be resolved. The findings indicated that 5% of the staff members
whose problems were resolved were women while 5.5% were man.

5.5.3 REFERRED TO OPD/ CASUALTY

About 4.9 % of clinic attendants were referred to the hospital OPD and or Casualty.
These are cases that the staff members in the clinic were unable to address and
needed the medical officer‟s attention. Most cases were either for needle prick, blood
gush and complications from the chronic illness.

5.5.4 REFERRED TO ICAS

Very few cases (0.3%) were referred to ICAS. ICAS was the contracted
sophisticated wellness program by the Gauteng Department of Health to assist the
staff members with problems that are above the skills of the appointed staff
members at the clinic. The staff members with these problems were referred to
ICAS.

44
5.5.5 REFERRED TO COURT

Only 0.1% of cases were referred to Court. Most cases that were referred to court
were cases that mostly deal with the law (Fowler, Fowler & Allen: 1992:266). It is
important for the staff in the clinic to realise and diagnose such cases, so that at the
end the staff members are assisted.

45
 CHAPTER 6
CONCLUSION AND RECOMMENDATIONS

In this chapter, the results are assessed in relation to the aims of the study, so that
appropriate conclusions can be drawn. The limitations to the study are also
articulated. Appropriate recommendations are made within the context of the findings
of the study. These recommendations provide the final suggestions for further
research.

6.1 CONCLUSIONS RELATED TO THE OBJECTIVES OF THE

STUDY
The study was the cross sectional study on the utilization of the wellness program
and the findings lead to the conclusions related to the objectives as follows:

6.1.1 DETERMINATION OF THE PROPORTION OF STAFF MEMBERS

WHO UTILIZED THE EWP DURING THE STUDY PERIOD

The findings of the study have indicated that at the end of the year the number of
visits represent 80.1 % of the staff members on the pay roll. This states that the total
number of visits represents 80% of the total staff complement and that actual
utilization per staff member is much lower, for example on the last month of the year
under study only 4.1%.attended the clinic.

6.1.2 DESCRIPTION OF THE DEMOGRAPHIC PROFILE OF THE

STAFF MEMBERS WHO UTILIZED THE EWP

Based on the study findings most women 90% utilised the services while only 10 %
were men. The nursing profession and occupation (56. 7%) was the most to use the
services, of which 57.9% were women and those working in the wards with the
patients than those not working with the patients.

46
6.1.3 DETERMINATION OF THE UTILIZATION RATE OF VARIOUS
COMPONENTS OF THE EWP DURING THE STUDY PERIOD

The component that was mostly utilised was the organisation and climate for
management of health related problems especially in the services of birth control for
family planning section, with 48.9 % attendance followed by the occupational health
and safety section with 17.4% attendance. The staff members who visited for a
health related problems were at 11.9% followed by those who sought the services for
HIV/AIDS with 9.8%.The staff members mostly utilised the birth control services.

6.1.4 DESCRIPTION OF THE OUTCOME BY THE SERVICE

COMPONENT RENDERED TO THE STAFF MEMBERS WHO
UTILIZED THE WELLNESS PROGRAM DURING THE STUDY
PERIOD

The study concluded that almost 86.9% of the staff members had to continue with
the services as their problems could not be resolved but needed a follow up, while
only 7.6% of cases were resolved. Very few cases were referred to the OPD/
casualty for medical officer‟s attention, some referred to court for legal matters and
others to ICAS for the highly sophisticated services.

A total of 41.1 % of cases that were resolved were for the HIV/AIDS services, with
32% for the occupational health and safety services.

6.2 LIMITATIONS

The limitations of the study are as follows:

 Since the study was a retrospective study based on secondary data analysis,
the limitations were therefore inherent in this methodology.
 Poor data quality like poor recording characterized by illegible hand writing
posed as a limitation to correct information, therefore some information or
subjects were not utilised in this study.
 The study also did not assess multiple visits, and thus could not assess
47
 proportion of staff who attended but number of visits per total staff
complement.

6.3 RECOMMENDATIONS

The recommendations to the study were based on the findings of the study and
therefore the following recommendations were suggested: Figure 6.1 illustrates the
Capacity for effective policy management. The figure indicates the dire need to have
skilled employees in the EWP section, who present with the ability to implement the
policy, having skills in human resources management with charisma attributes to be
able to stand in for the staff members‟ well-being as advocates, and not only accept
what is presented or given in terms of their work. Above all the section needs an
initiative leader who will be able to lead the program.

Figure 6.1 Capacity for effective policy management

48
Furthermore, it is crucial that the staff members with the above illustrated attributes
are able to fit within the requirements for the EWP and implement the Organisation
relevant/culture components as illustrated below:

Figure 6.2 Organization relevant/culture components

 The importance of disease prevention programs, health promotion programs

and lifestyle related programs was noted and must be fitted into EWP. The
improvement of staff members‟ life in areas of fitness level, mood, health
awareness, nutritional habits and health status is crucial and must be included
in the program. The service is poor in the identification of stress and
depression challenges. This should be up-scaled.
 The employer must include areas around risk assessment that will identify risks
to the staff members‟ health, fitness that reduce risk to illness, health education
on the importance of ensuring healthy living and management of illness and
ensuring that the EWP staff members implement the program effectively and
capacitate the staff members. Assessments should include biometric screening
for cardiovascular disease risk factors as well as behaviour risk factors.
 The company must build a progressive culture which also consider the
49
 inclusion of the strategies that encourages the staff members to utilize the
wellness program. It seems a waste of resources to have an entire wellness
program where staff members using it primarily for family planning.
 The organizations to consider and emphasize the comprehensive wellness
programs that not only depend on the visit by the staff members but look at all
activities such as aerobic exercise programs, reduction of body weight and
healthy eating plans and ensured implementation thereof.
 HIV/AIDS workplace employee assistant program to include preventative
programs, education and support groupings and then ensure that attendance is
compulsory for all the staff members.
 Implement comprehensive wellness program that consider preventative,
promotion, curative and rehabilitative health programs.

6.4 USE OF FINDINGS OF THE STUDY

A report on the findings and suggested guidelines is documented and submitted for
publication and would be submitted to relevant authorities of the University of
Witwatersrand, Gauteng Provincial Department of Health and Natalspruit hospital.
Lastly the report would be presented to the staff members at Natalspruit hospital,
wellness section staff members and other Gauteng hospitals staff members.

6.5 FUTURE RESEARCH

The following are area of research that the researcher believes are important:
 The impact of the utilization of the wellness program by the staff members on
their own life and on the development of economy of the organisation.
 Unpacking of the wellness program package to analyse if it is in line with staff
members‟ needs and requirements in the improvement of their personal and
work life and that of their family members.
 Cost effectiveness of the provision of the EWP in the hospital.
 To assess if the managers are living by example. Do they utilize the service?
This would create a further buy-in from employees that the service is of good
standard.
50
  The program managers should further investigate why men and other
professions other than nurses are not using the wellness program optimally.
This could be done through interviews or questionnaires. This would greatly
assist in structuring a program that is acceptable to all.

6.6 SUMMARY AND CONCLUSION

Utilization of wellness program in the regional hospital, Natalspruit hospital has been
described. It is concluded that 80% of the staff members appointed in the hospital
recorded to have utilized the wellness clinic in a period of one year.

The demographics of these staff members were also determined whereby female
utilized the services more than men, mostly of the nursing profession working in the
wards.

The rate of utilization of various components were also determined and the findings
indicated that most services utilized were the organisation and climate for
management of health related problems especially in the services of birth control for
family planning services and to a fair percentages, the occupational health and
safety and HIV/AIDS components. The implementation, utilization process and the
components used raised a concern and it was then important that the requirements
for the effective EWP and especially the need for the capacity for effective policy
management and organisation relevant/culture components be presented as
recommendations.

Therefore it is concluded that the report findings could benefit the Government in
planning and operations of other Wellness Programs across the country.

51
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APPENDICES

1
APPENDIX A: ETHICS CLEARANCE CERTIFICATE

1
1
APPENDIX B: APPROVAL FROM POST GRADUATE COMMITTEE

2
1
APPENDIX C: APPROVAL FROM NATALSPRUIT HOSPITAL
MANAGEMENT

2
1
APPENDIX D: DATA COLLECTION TOOLS

2
TOOL 1: NUMBER OF STAFF MEMBERS UTILIZED WELLNESS PROGRAM IN 2009
TOTAL NUMBER OF NUMBER OF STAFF MEMBERS
STAFF IN THE HOSPITAL UTILIZED WELLNESS PROGRAM
JAN
FEB
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER

GRAND TOTAL

3
TOOL 2: STAFF MEMBERS’ DEMOGRAPHIC DATA

STUDY SURNAME NAME DATE AGE GENDER OCCUPATION WORK PROFESSION

NO OF AL CATEGORY SECTION
VIST

4
TOOL 3: OUTCOME BY THE SERVICES
STUDY DATE VISIT TYPE COMPONENT REASON FOR OUTCOME
NO OF ATTENDED VISIT
VISIT
INITIAL/ (HIV/ OHS/ (VCT/ NEEDLE (RESOLV/ UNRESOLV/
ONGOING PSYCHOSOCIAL/ STICK/ ABUSE/ CONT/ REFER)
HEALTH FAMILY
RELATED/ PROBLEMS/
OTHERS) FAMILY
PLANNING)