The company has to be in a good place itself if it wants to do this well.
If [workers] sense a lack of true commitment to their health as evidenced by a safety program that is considered ineffective, you are not going to get anywhere.
During the course of the workshop itself, several points were repeated, demonstrating the dynamic tensions between workplace safety and health protection efforts and health promotion activities. These included the importance of privacy issues (Chang, McLellan, Nguyen); the need for more evidence on Total Worker Health interventions (Lessin, Newman); and the need for a workplace culture that supports and promotes the principles of Total Worker Health (Carson, Duval, Howe, McLellan, Scibelli, Wald).
In this final workshop session, moderated by Glorian Sorensen, Professor of Social and Behavioral Sciences, Harvard School of Public Health, and Vice President for Faculty Development, Dana-Farber Cancer Institute, a four-person reactor panel presented their impressions of the day’s presentations and identified several additional themes, followed by a brief discussion period. Reactors included LuAnn Heinen, Director, Institute on Health, Productivity and Human Capital, and Vice President, National Business Group on Health; Nicolaas Pronk, Vice President for Health Management and Chief Science Officer, HealthPartners, Inc; and
Margaret Robbins, National Director, Occupational Safety and Health, Coalition of Kaiser Permanente Unions.
Several common elements come to the fore in the kinds of programs discussed during the workshop, including (1) leader recognition and prioritization of Total Worker Health in the business’s culture; (2) a comprehensive perspective on workplace safety and hazard reduction, including systemic factors that should be addressed; and (3) attention to the wellness and health promotion activities that can produce healthier, happier, more satisfied workers, which ultimately can have a positive effect on business goals.
Heinen reflected on the fact that while the topics discussed are very relevant to her audience (mostly private, large, self-insured employers), many have not overcome their organizational silos. They have wellness programs. They have safety programs. But they are not well-integrated at this point in time. She lauded the workshop participants as being leaders in Total Worker Health, noting their corporate support and visionary, committed, and long-tenured program leaders.
Even if employer concerns about health care costs were to disappear tomorrow, she said, their interest in safety and wellness would continue, through their interest in business outcomes like absenteeism and presenteeism as well as attracting and keeping healthy workers on the job. Some data from the National Business Group on Health suggest that employee engagement and wellness programs are highly correlated with recruitment, retention, and reduced workers’ compensation claims, independent of health care cost impact. To employers, these are important measures of productivity. Heinen concluded by saying that more documentation of positive outcomes is needed to make the business case for Total Worker Health, and that “every individual organization and every company needs its own very specific business case for why this matters.”
Pronk first pointed to the need for a “human-centered approach” that includes building trust and respect. This also includes using participatory approaches that intentionally include the views and opinions of workers so when it comes to operating the programs, “You make sure that you have representation from every level of the organization,” he said. Other factors he noted to be important to successful integration of health and safety include leadership support, training at multiple levels (including
managerial), the formation of integrated multifunctional teams, and setting measurable goals at multiple levels. He also noted a focus on community ties. Pronk indicated that there are challenges associated with trying to define what a “culture of health” really means. Certainly, substantial variability exists in what it means for one company versus another company, he said.
Pronk noted several barriers to integration, including leadership support and training, accountability at multiple levels of the organization, building the business case for action, and bridging silos. Additionally, cost to an organization, particularly the small- and medium-sized businesses, may be a big barrier, he said.
Pronk also noted that health and well-being has many components and should not be viewed as simply one single number; health and well-being is multidimensional and complex. It is related to indicators of individual health but also to the physical, psychosocial, and socioeconomic environments of people. Measuring it is notoriously difficult and challenging. He said there may be an opportunity to think about a summary measure of health and well-being, a summary measure of safety, and then a summary measure of integration. Finally, in terms of scalability and sustainability of successful programs, “connecting to the community is absolutely key,” Pronk said, and organizations should look for partners in their local community (including non-traditional partners) to be part of the conversation.
Teamwork across the many different health and safety domains, as well as human resources, benefits, employee assistance programs, and so on, is not necessarily easy, said Robbins. An initial step is to acknowledge each domain brings a perspective and approach about worker health and safety and how to improve it that others may not share. Building a shared understanding about ways to accomplish Total Worker Health together, respecting everyone’s perspective, would be a significant accomplishment.
For an employer’s Total Worker Health program to take hold requires that the following preconditions be in place, she said:
- Adequate wages, basic health and related benefits, and an effective safety program, in order to demonstrate concern for workers’ health and well-being, which can lead to worker buy-in and participation;
- Commitment to assessing work environments and processes longer term;
- Having employee representative participation from the outset, including participation in defining for the program what health is and how money is spent on the workers’ behalf; and
- Voluntary nature of the program.
On this last theme, Robbins said there is a need for a community approach to Total Worker Health. In the past, when more health departments had occupational health staff and greater outreach capacity, they could reach worker communities not touched by employer programs—small workforces, contingent, part-time, seasonal, or marginal workers, for example.
Now it takes greater effort and some tailoring to determine which parts of a community should be part of the wellness conversation for a specific employer, said Robert McLellan of Dartmouth-Hitchcock. In some situations, the Chamber of Commerce might be a good partner; in others, it might be a local migrant group.
In Colorado, Lee Newman, Colorado School of Public Health and Axion Health, Inc., said his team has learned that what “friends and family” think of the employee wellness program is very important. He also emphasized the importance of the “evisceration” of local public health focused on occupational health and safety. He noted that in the coming year, they will be enlisting community health workers in local health departments to be trained in talking to small businesses about Total Worker Health principles.
Following on the theme of the importance of community, Nancy Lessin, United Steelworkers–Tony Mazzocchi Center, used the example of cancer prevention saying that while a lot of attention has been paid to lifestyle issues, employers first need to ensure that exposures to carcinogens in the workplace are removed or mitigated.
Employers have three principal motivations for launching a Total Worker Health program, said Greg Howe, Lincoln Industries:
- The humanistic motivation—simply, a belief in the importance of workers’ health and a healthy company culture;
- The need to adhere to regulations that are enforced; and
- The economic imperative, which may turn out to be the most important, if these programs and practices do ultimately connect with good business outcomes.