Safety 2020 (Virtual): Broadening Safety Programs with Total Worker Health

At Safety 2020, the annual conference of the American Society of Safety Professionals, delivered virtually amid the COVID-19 pandemic, Jenn Cavallari, Associate Professor at UConn School of Medicine, encouraged safety professionals to implement the principles of Total Worker Health, an initiative of the National Institute for Occupational Safety and Health (NIOSH), to improve safety performance by broadening their approach to worker well-being.

Employers pay a large share of costs associated with poor worker health, noted Cavallari, and direct medical costs are just the tip of the iceberg. Indirect costs such as lost productivity can be two to three times higher than the direct costs of poor worker health. With nearly 50 percent of Americans managing at least one chronic health condition, the potential benefits to be gained from improving worker well-being are significant.

Even in organizations that offer health and well-being programs, such initiatives are often siloed from occupational safety and health programs, and coordination between these areas is rare. But there is significant overlap between the causes of many injuries, illnesses, and health conditions, from musculoskeletal disorders to heart disease, with both occupational and non-occupational factors playing a role. And with the COVID-19 pandemic, Cavallari pointed out, the lines between work and home are blurred more than ever. Whether it’s an office employee working remotely amid all the distractions of home and family or a front-line worker concerned about exposing her family to COVID-19, occupational and non-occupational concerns are intertwined like never before.

Total Worker Health (TWH) recognizes this interplay and aims to coordinate well-being efforts across workplace and non-workplace factors for better effectiveness. NIOSH defines the concept as “policies, programs, and practices that integrate protection form work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.” TWH incorporates both the domains occupational safety professionals have traditionally been concerned with, such as machine guarding, chemical exposure, and other workplace hazards, and the broader personal and community factors that affect health outcomes.

For safety professionals, TWH represents a broader mindset, Cavallari explained. While safety professionals aim to send employees home in the same state of health as when they began the workday, TWH aims to improve worker health, not merely maintain the status quo.

But, Cavallari cautioned, it’s important to understand what TWH is not. It is not a wellness program implemented without simultaneously providing safe and healthy working conditions, nor is it a collection of health-promotion efforts at a workplace where the way work is organized contributes to worker injuries and illnesses. In addition, programs that place the burden of change on the individual without addressing systemic work-related factors are not TWH. For example, a program with a goal of employee stress reduction cannot simply encourage employees to engage in stress-reducing activities such as exercise and meditation without simultaneously examining the work-related root causes of stress and seeking to improve them.

Fundamentals of Total Worker Health

Five concepts are fundamental to a TWH approach:

1. Demonstrate leadership commitment to worker safety and health, through both words and actions.
2. Design work to eliminate or reduce safety and health hazards and promote worker well-being. The following hierarchy of controls can help to identify and prioritize the types of changes to implement, with systematic changes generally preferred over individual or behavioral changes:
   • Eliminate working conditions that threaten safety, health, and well-being.
   • Substitute health-enhancing policies, programs, and practices.
   • Redesign the work environment for safety, health, and well-being.
   • Educate for safety and health.
   • Encourage personal change.
3. Promote and support worker engagement throughout program design and implementation. Employees are the experts not only on their own jobs, but also on their own well-being and the factors that help or undermine it. Employers should leverage that knowledge to identify challenges, design interventions, and gain buy-in for program initiatives.
4. Ensure the confidentiality and privacy of workers. While NIOSH recommends data-driven approaches, it’s critical to ensure that any confidential health information is protected and used only to support the program goals.
5. Integrate relevant systems to advance worker well-being. A number of workplace programs affect worker well-being, from occupational safety and health to health insurance benefits, employee assistance programs (EAPs), compensation, and many more. It’s critical to identify the ways these programs can support one another.

Resources and Tools

Cavallari highlighted an available free resource for employers interested in implementing a TWH program. Developed by the Center for the Promotion of Health in the New England Workplace (CPH-NEW), a TWH Center for Excellence funded by NIOSH and composed of faculty, staff, and students from the University of Massachusetts Lowell and the University of Connecticut, the Healthy Workplace Participatory Program (HWPP) focuses specifically on leveraging employee engagement to improve safety and health outcomes. It consists of three core elements:

• A two-committee structure that provides roles and communication opportunities for both management and line-level workers to interact around safety and health issues. Managers sit on the steering committee, which sets overall goals and direction, while front-line employees make up the design team, which develops solutions to specific safety and health concerns.
• A facilitator who organizes the communication and work of the two committees. The facilitator can be a safety professional or another individual willing and able to coordinate the program.
• A step-by-step process for intervention planning, known as the Intervention Design and Analysis Scorecard (IDEAS) tool. The process begins by selecting a safety or well-being concern to focus on, then proceeds as follows:
  1. Identify root causes.
  2. Develop measurable objectives and solution activities.
  3. Set criteria for selecting and evaluating interventions.
  4. Form interventions and apply selection criteria.
  5. Rate and select intervention options.
  6. Plan and implement interventions.
  7. Monitor and evaluate interventions.

Before launching the HWPP, Cavallari recommended considering organizational readiness by asking the following questions:

• Are there resources available to implement well-being activities proposed by workers?
• Are employees available to work in teams?
• Is a facilitator available?
• Is safety and health expertise available?
• Is communication around safety and health issues functional?

For organizations interested in exploring TWH approaches but not quite ready to implement a full-blown program, Cavallari recommended three ways to introduce TWH practices in the workplace:

• Find out what employees think are the obstacles to their well-being. This can be done formally, such as through an employee survey, or informally, through casual conversation and dialogue.
• Get to know other program managers, and add well-being aspects to current programs and initiatives throughout the organization.
• Engage employees by creating opportunities for them to solve problems and seeking their feedback on safety, health, and well-being initiatives.