Jul 19, 2019
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Fundamentals of Total Worker Health
Keeping workers safe is the foundation upon which a TWH approach is built. Total Worker Health integrates health protection efforts with a broad spectrum of interventions to improve worker health and well-being.
The Fundamentals of Total Worker Health Approaches is the practical starting point for employers, workers, labor representatives, and other professionals interested in implementing workplace safety and health programs aligned with the Total Worker Health (TWH) approach. There are five Defining Elements of TWH:
Element 1: Demonstrate leadership commitment to worker safety and health at all levels of the organization.
Element 2: Design work to eliminate or reduce safety and health hazards and promote worker well-being.
Element 3: Promote and support worker engagement throughout program design and implementation.
Element 4: Ensure the confidentiality and privacy of workers.
Element 5: Integrate relevant systems to advance worker well-being.
Create a team of people who know about different policies, programs, and practices in your workplace that impact worker safety, health, and well-being. Draw team members from all levels of the workforce, and consider including the following:
Defining Element 1: Demonstrate leadership commitment to worker safety and health at all levels of the organization
Organizational leaders should acknowledge and communicate the value of workforce safety and health as a core function, and they should prioritize worker safety and health on the same level as the quality of services and products.
ProTip: Middle management is the direct link between workers and upper management and plays a critical role in program success or failure. For example, supervisors often serve as gatekeepers to employee participation in programs, and when program involvement competes with productivity demands, they may discourage employee participation
Effective programs thrive in organizations that promote respect throughout the organization and encourage active worker participation, input, and involvement. Leaders at all levels of the organization can help set this tone, but everyone (from managers down to front-line workers) plays an essential role in contributing to this shared commitment to safety and health. Beyond written policies, stated practices, and implemented programs that endorse safety and health in your workplace, consider the extent to which your organization’s spoken and unspoken beliefs and values either support or deter worker well-being [CPWR and NIOSH 2013].
Encourage top leaders to:
Encourage mid-level management to:
Defining Element 2: Design work to eliminate or reduce safety and health hazards and promote worker well-being
A Total Worker Health approach prioritizes a hazard-free work environment for all workers. It applies a prevention approach that is consistent with traditional occupational safety and health prevention principles of the Hierarchy of Controls.
Eliminating or reducing recognized hazards in the workplace first, including those related to the organization of work itself, is the most effective means of prevention and thus is foundational to all Total Worker Health principles. Although some hazards can be eliminated from the work environment, others (such as shift work) are more difficult to change. These must be managed through various engineering, administrative, or (as the very last resort) individual-level changes. Workplace programs that adopt a TWH approach emphasize elimination or control of workplace hazards and other contributors to inadequate safety, health, and well-being. This emphasis on addressing environmental determinants of health is a crucial concept for TWH programs.
The Hierarchy of Controls Applied to NIOSH Total Worker Health® provides a conceptual model for prioritizing efforts to advance worker safety, health, and well-being. This applied model is based on the traditional Hierarchy of Controls well-known to occupational safety and health professionals.
As in the traditional Hierarchy of Controls, controls, and strategies are presented in descending order of anticipated effectiveness and protectiveness, as suggested by the cascading arrows. The Hierarchy of Controls Applied to NIOSH Total Worker Health expands the traditional hierarchy from occupational safety and health to include controls and strategies that more broadly advance worker well-being.
The Hierarchy of Controls Applied to NIOSH Total Worker Health is not meant to replace the traditional Hierarchy of Controls, but rather is a companion to this important occupational safety and health model. It serves to illustrate how TWH approaches emphasize organizational-level interventions to protect workers’ safety, health, and well-being. To apply this model:
Using the Hierarchy of Controls Applied to NIOSH Total Worker Health, a program targeting reductions in musculoskeletal disorders could consist of the following:
Reorganizing or redesigning the work to minimize repetitive movement, excessive force, and awkward postures
Providing ergonomic consultations to workers to improve job and workstation design and interface, along with training in ergonomic principles and opportunities for workers to participate in design efforts
Evaluating the age profile and health needs of the workforce to provide education on self-management strategies (including preventive exercise) for arthritis or other musculoskeletal conditions that impact the physical ability
Similarly, a TWH program reducing work-related stress might consider the following:
Implementing organizational and management policies that give workers more flexibility and control over their work and schedules, as well as opportunities to identify and eliminate root causes of stress
Providing training for supervisors on approaches to address stressful working conditions
Providing skill-building interventions for stress reduction for all workers and providing access to the Employee Assistance Program
Defining Element 3: Promote and support worker engagement throughout program design and implementation
Ensure that workers involved in daily operations, as well as supervisory staff, are engaged in identifying safety and health issues, contributing to program design, and participating in all aspects of program implementation and evaluation. Again, letting workers be involved in workplace safety, health, and well-being, instead of being just recipients of services, nurtures a shared commitment to Total Worker Health. Some ways to do this include:
ProTip: Design programs with a long-term outlook to ensure sustainability. Short-term approaches have short-term value. Programs aligned with the core values of the organization will likely last. These should be flexible enough to be responsive to changes in workforce and market conditions, workplace hazards and exposures, and the needs of individual workers. A participatory approach can help in this regard, but keep sustainability in mind for the bigger picture.
To help encourage worker engagement, communicate strategically; everyone with a stake in worker safety and health (workers, their families, supervisors, etc.) must know what you are doing and why. Tailor your messages and how they are delivered, and make sure they consistently reflect the values and direction of the initiative.
Whether workers are willing to engage in workplace safety and health initiatives, however, may depend on their perceptions of whether the work environment truly supports safety and health. For example, one study found that blue-collar workers who smoke are more likely to quit and stay quit after a worksite tobacco cessation program if workplace dust, fumes, and vapors are controlled and workplace smoking policies are in place
Defining Element 4: Ensure the confidentiality and privacy of workers
Designing and enforcing appropriate privacy protections goes beyond ensuring that only authorized personnel has access to sensitive safety and health information. Observe all relevant local, state, and national laws regarding the privacy of personally identifiable data and health-related information by taking appropriate steps. So doing things like masking personally identifiable information on reports, and using a digital management system that is encrypted and protected by user passwords are some best practices.
Data sources that require confidentiality considerations and/or protections:
Defining Element 5: Integrate relevant systems to advance worker well-being.
Total Worker Health emphasizes the role that organizations have in shaping worker safety and health outcomes, recognizing that a multilevel perspective that includes policy, environmental, organizational, and social concerns may be best for tackling complex challenges to worker safety, health, and well-being. Integrating data systems across programs and among vendors, for instance, can simplify monitoring and evaluation while also enabling both tracking of results and continual program improvement.
Consider ways to integrate relevant systems within your organization:
Questions to Consider Asking Yourself or Your Team
Understanding the connections between various systems and levels of an individual worker’s experience may help design creative, well-rounded approaches to safety and health challenges.
By working together and discovering what each professional in the organization is already working on you will often find related goals and objectives - the benefits administrator struggling to get workers to participate in an exercise class and the safety professional struggling to get a warm-up/stretching program started will be able to work together. So to put a pin in this topic, I will say this: If you want to have a successful wellness program, you must first have a strong culture of workplace safety. Then you can build on that credibility and ask folks to move toward participating in safety or health-related activities off-the-job. Make sure you are first building a workplace safety culture.
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