Total Worker Health Approach Helps Organizations and Employees Thrive

A synergistic approach for integrating occupational safety and health protection with health promotion reduces costs, increases employee productivity, and boosts organizational performance.

• By Brenda Schmidt, Robert Eric Dinenberg
• Jul 01, 2014

Synergy is the interaction of multiple elements in a system to produce an effect greater than the sum of their individual parts; the term synergy comes from the Greek word synergos, meaning "working together."

We've all seen the positive impact of synergy in our work, play, or in our journey to health. The football win that is greater than the capabilities of the individual players. The culmination of a project at work that far exceeds the expectations or contributions of any individual team member. The health care team that works together to save lives in an effort that never could have been delivered by one individual member of the team alone.

The synergistic effect of teaming Occupational Safety and Health (OSH) and Worksite Health Promotion (WHP) has been known for quite some time. In 1984, NIOSH concluded that the integration of OSH and WHP integration would "make possible a 'synergism of prevention' to improve the health of workers through comprehensive risk reduction."¹

We now have a body of research that points to benefits found in integrating health protection and health promotion at the workplace.

In the November 2013 issue of Occupational Health & Safety, based on research, we made the business case for integrating health protection and health promotion. Studies show integrated health protection/health promotion programs can be more effective than health promotion programs alone. The literature shows that a comprehensive effort to promote employee health and well-being, reduce health risks of the workforce, and lessen the complications of chronic disease for employees can reduce health care costs, increase productivity, and boost organizational performance.

In today's 24/7 society, mounting workplace pressures can take a toll on employees' health and well-being. Building a thriving workplace in which the healthy choice for employees is the easy choice, supported by safe and healthy environments and policy, is yielding a return on value for all stakeholders.²

Employees working for employers who intentionally create a culture of health feel greater job satisfaction, higher morale, and better physical and mental health. They are more motivated, able to manage stress, and rally to meet the constant changes and increasing demands in today's workplace. Organizations that foster a culture of health reap greater productivity and reduced absenteeism, presenteeism, and turnover. Staffers suffer fewer accidents and injuries. Healthy and safe workplaces not only save on costs, but also are better positioned to attract and retain top-quality employees and provide optimum customer service in competitive global markets.

Evidence shows that Worksite Health Promotion programs that integrate Occupational Safety and Health and emphasize correcting workplace hazards show greater employee participation and engagement than those that focus only on individual behavior change.³

Employer efforts to create a safe and healthy workplace foster a climate of trust, making workers more receptive to messages from their employer to change their individual health behaviors and habits.

Total Worker Health
The NIOSH Total Worker Health^TM (TWH^TM) strategy integrates occupational safety and health protection with health promotion to prevent worker injury and illness and to advance worker health and well-being. This synergistic approach, which has emerged through rigorous research, helps create and strengthen a culture of health in which employee well-being and organizational success are inextricably bound. Both the organization and individual employees support this culture. In settings where a strong culture of health and safety exists, employees’ personal interests, organizational strategic goals, and business performance are aligned and congruent.

Traditionally, workplace health and safety programs have been compartmentalized into separate silos, but increasing evidence shows that coordinating and integrating those programs leads to healthier workers and workplaces.⁴ Health protection programs have targeted safety to reduce workers' exposures to physical, biological, chemical and psychosocial hazards. Health promotion programs typically focus exclusively on individual lifestyle factors like poor nutrition, lack of exercise, and smoking, which place workers and their families at risk for developing chronic illness such as cardiovascular disease, diabetes, cancer, and pulmonary diseases.

The TWH™ strategy integrates the two areas of health protection and health promotion. It supports the development and adoption of ground-breaking research conducted by the five Total Worker Health Centers of Excellence and best practices of integrative approaches that address health risk from the work environment (physical and organizational) and individual behavior.

Interventions
Interventions that are consistent with a Total Worker Health strategy may include:

• Providing mandatory respiratory protection programs that also support tobacco cessation.
• Integrating ergonomics and joint health and arthritis prevention and management strategies.
• Developing stress management efforts that reduce workplace stress and build worker resiliency.
• Implementing training programs for workers that reduce hazards and risks on the job and assess individual risks, such as risk for developing diabetes.
• Exploring models that combine occupational health services with workplace primary care.

Integrated approaches to workplace health have demonstrated success in a variety of ways, including:

• Improving healthy behaviors such as smoking cessation, better nutrition, and increased physical activity.
• Increasing employee participation in occupational safety and health and health promotion programs.
• Reducing occupational injury rates.
• Lowering health care, administrative, and lost productivity costs.

Part of the Fiber of Organizations
To work most effectively, Total Worker Health requires executive leadership buy-in and to be a visible priority at every level of the organization. Management must work hand in hand with internal communications staff so employees fully understand health and safety priorities and the intent of the program. Employees must be engaged in the process of creating a culture of health and helping to evaluate the success of an integrated program of health protection and health promotion. Total Worker Health cannot be a bolt-on program. It has to be etched into the mission of an organization, incorporated into its values and woven into the fiber of how an organization operates and does business.

TWH requires busting through the separate silos mentality, so that those areas responsible for health promotion, occupational safety and health, and human resources and employee benefits coordinate and are on the same page. Health and safety must be the responsibility of both management and individual employees. In an organization that employs Total Worker Health effectively, leadership and grassroots employees are actively engaged in decision-making that affects the health and safety of staff at every level. Incentive and recognition programs should be aligned effectively to reward and recognize safe and healthy behavior and to build the momentum of TWH within a healthy culture.

Sustaining Momentum
Maintaining an integrated approach in the workplace requires thoughtful and creative leaders who inspire others to “walk the talk” of health and safety. It demands leaders who seek out and listen to employee suggestions for continuing to improve the program. Leaders must be interested in adjusting the Total Worker Health strategy to meet the needs and interests of a workforce that is increasingly older and ethnically diverse. It requires leaders who endorse and advocate for the technological innovations necessary to support an evolving program. TWH flourishes when “champions” or “ambassadors”--those informal leaders throughout an organization--help to continuously assess the effectiveness of the program to keep it fresh and relevant.

Progressive companies and organizations that are transitioning this robust research-based strategy into the workplace are reaping rewards. Organizations in industries as diverse as health care, law enforcement, hospitality, and finance are employing the successful, evidence-based approach of TWH to proactively identify and prevent the common causes of injury, illness, and chronic conditions unique to their employee populations to improve staff health, safety, and wellness.

Johnson & Johnson has supported an integrated system for worker health since the late 1970s. A number of other world-class organizations also have instituted health protection and health promotion programs.⁵ These include such diverse organizations as Caterpillar, CIGNA Corporation, Daimler-Chrysler/United Auto Workers, Union Pacific Railroad, Citibank, Toyota, and the National Aeronautics and Space Administration.

Health Coach Training
Not surprisingly, the health care sector is fertile soil for integrating a Total Worker Health program. Savvy health care organizations know that healthier, safer, and more satisfied employees are correlated with lower hospital readmissions, higher patient satisfaction, and financially healthy organizations.⁶

It is exciting to develop tools for and help guide the implementation of a Total Worker Health approach at work sites. A work site health and safety audit that asks employees their perceptions of the work culture and how their employer supports their health and well-being lets staffers know their opinions count and helps to engage employees in their health and wellness from the start.

Following on-site health risk assessments, motivational interviewing is effective in engaging employees to take personal responsibility for changing their behavior to make safer and healthier choices. This collaborative health coaching style honors staff autonomy and perspectives, drawing on employees' individual intrinsic motivations and employing the organization's available resources to make changes. It flips the "do what I say" approach to health care on its head, appealing to what an individual values and what is meaningful in his or her life. This coaching technique invites employees to take responsibility and ownership for their health, instead of having someone tell them what to do.

To break down silos, major health care systems are appointing director-level executives who have employee health, safety, and wellness in their title with health protection and health promotion under their purview. Some medical centers are considering integrating TWH into residency programs so physicians are on board with an integrated approach to health and safety from the beginning of their careers. Other health care systems are adapting traditional health risk assessment questions into mandatory safety and health resource training for employees that highlights the resources the health systems provide.

This novel approach matches the needs of employees and resources available—think of smoking cessation programs, indoor/outdoor exercise facilities, healthy cafeteria and vending machine options, and restful break areas--instead of taking an attitude of "we are going to poke and prod you and identify your individual health risks and make you do something about it."

Because the health of our nation depends upon the health of our workforce, any action that "makes possible a 'synergism of prevention' to improve the health of workers" is an action that makes us all stronger and healthier. The synergistic integration of health protection and health promotion with a focus on corporate culture is yielding results today that are greater than the sum of the parts--for organizations, employers, employees, and the communities where we work and live.

References
1. National Institute for Occupational Safety and Health. NIOSH program plan by program areas for fiscal years 1984-89, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, Rockville, MD, 1984.

2. Fabius R., et al. The link between workforce health and safety and the health of the bottom line: tracking market performance in companies that nurture a "culture of health." JOEM. 2013; 55(9);993-1000.

3. Sorensen, G. and E. Barbeau, Steps to a Healthier U.S. Workforce: Integrating Occupational Health and Safety and Worksite Health Promotion: State of the Science 2004, Paper commissioned for the National Institute for Occupational Safety and Health.

4. Hymel, P.A., et al., Workplace Health Protection and Promotion: A New Pathway for a Healthier-and-Safer Workforce, J Occup Environ Med, 2011, 53(6):p. 695-702).

5. Goetzel, R.Z., Steps to a Healthier U.S. Workforce: Examining the Value of Integrating Occupational Health and Safety and Health Promotion Programs in the Workplace, 2005, Paper commissioned for the National Institute for Occupational Safety and Health.

6. Press Ganey. Return on Investment: Increasing Profitability by Improving Patient Satisfaction. 2012.

This article originally appeared in the July 2014 issue of Occupational Health & Safety.