Integrated Strategies for Worker Safety and Health: A Conceptual Model for Intervention and Research

Transcription

1 Integrated Strategies for Worker Safety and Health: A Conceptual Model for Intervention and Research Glorian Sorensen, PhD, MPH Glorian_Sorensen@dfci.harvard.edu February 22, 2018

2 Our Shared Goal Protect and promote worker safety, health, and well-being

3 What is it? Today s Objectives Define what we mean by integrated approaches for worker safety, health, and well-being Why do it? Describe the value added to organizations Will it work? Present evidence for this model How? Identify key resources for implementing an integrated approach to worker health, safety, and well-being

4 Starting with some background

5 Standard Model for Worksite Health Protection & Promotion Supporting healthier behaviors through workplace environments and services offered at work Preventing workrelated illness and injury Reducing work-related stress Expanding workrelated resources and opportunities Health screening & services Promoting healthy behaviors Creating a healthpromoting environment Workplace safety measures Control of workplace hazards Improved ergonomics Health and safety training Decreasing job strain Fostering social support among workers Stress management Supporting work-family balance (e.g., through flexible schedules) Medical care benefits Paid sick and personal leave Child and elder care services Job training & education Adequate wages and salaries Egerter et al., Commissionhealth.org, RWJH, 2008.

6 Where are the gaps? What s optimal? Siloed approach Low participation rates Focus on individual workers Focus on downstream outcomes Integrated & coordinated Engaged employees Population approach Addresses root causes

7 Where does your organization sit on this continuum?

8 A New Paradigm: Identifying root causes in working conditions Physical Exposures to safety and health hazards Organization Hours worked Workload and pace of work Inadequate benefits (Wages, Leave, Flexibility) Inconsistent breaks Limited access to resources on the job Psychosocial Job stress Low supervisor support Co-worker social norms Culture of health and safety at work Conditions of Work Organization Psychosocial Physical Worker Health and Safety

9 Modifying Working Conditions for Improved Outcomes Integrated Policies, Programs, and Practices Conditions of Work Physical Environment Organization of Work Psychosocial Factors Worker Outcomes Injury Illness Wellbeing Worker health & safety behaviors, knowledge and skills Enterprise Outcomes Productivity & Quality Turnover & Absence Health Care Costs

10 Key Take-Away Messages Working conditions are often root causes of poor health and safety outcomes. Improving working conditions can optimize employee and employer outcomes. An upstream systems approach can improve working conditions and contribute to building a culture of health.

11 What is it?

12 An integrated solution is a management system approach to worker safety, health, & well-being shaped by employee input & participation Starts with providing a safe work environment Builds on traditional health protection & promotion efforts Emphasizes policies & practices that create: Organizational changes promoting safety & health Positive working conditions Aims to improve employee & employer outcomes

13 NIOSH Total Worker Health Total Worker Health is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. ( 13

14 Why do it? What s the value added? Improve effectiveness of worksite strategies to improve worker health Improve outcomes Increase participation Enhance a culture of trust Manage costs Reduce absence, turnover Generate revenue Improve job satisfaction & engagement Improve market performance Promote brand reputation Fabius et al. J Occup Environ Med. 2016;58:3-8.

15 How does this approach contribute to meeting your goals or objectives?

16 What s the evidence? Will it work?

17 Peder Severin Kroyer ( ). Danish painter. The Iron Foundry, Burmeister & Wain, National Museum of Art. Copenhagen. Denmark.

18 WellWorks-2: Study hypothesis The integration of health protection with health promotion will enhance the intervention impact on behavior change over and above health promotion alone.

19 Integrated prevention approaches needed WellWorks-2: Manufacturing Baseline Assessments in 15 worksites (n=9,019) Health Promotion Randomization Final Assessments Health Promotion plus OSH Intervention Labor - management participation in program planning Management consultation for changes in the work environment Group and individual education for workers Sorensen et al, Cancer Causes Control 2002;13:

20 Quit rates Adjusted six-month quit rates at final by intervention and job type (cohort of smokers at baseline: n=880) HP/OSH final HP final Hourly workers Salaried workers Sorensen et al, Cancer Causes and Control, 2002

21 Recent Findings: Health and safety outcomes share common root causes in working conditions.

22 Boston Hospital Workers Health Study Collaboration with Partners Healthcare Datasets 3 surveys of patient care workers at 2 hospitals Response rates = 71-79% Nurse manager surveys Administrative databases 30+ peer-reviewed manuscripts published

23 Attending to the Conditions of Work: Summary Findings for Healthcare Workers CONDITIONS OF WORK Physical Environment Job Demands Organization of Work Ergonomic Practices Job Flexibility Inadequate staffing Shift schedule/control Psychosocial Factors Low decision latitude Coworker/supervisor support Work-family conflict Harassment WORKER OUTCOMES Pain Work interferences Cardiometabolic risk WORKER PROXIMAL OUTCOMES Sleep deficiency Fatigue Physical Activity Psychological distress BMI Sorensen et al, JOEM 2011; Nelson et al, AJPM 2014; Sabbath et al, AJIM 2013; Kim et al, AJIM 2012; Buxton et al, JOEM 2012; Reme et al, J Occup Rehabil 2012; Dennerlein et al, AJIM 2012; Umukoro et al, JOEM 2013; Nelson et al, Am J Prev Med 2014; Jacobsen et al, Am J Ind Med 2014; Hopcia et al, Workplace Health Saf 2012; Hurtado et al, Work & Fam 2015.

24 Examples of Shared Pathways Supervisor support Bullying at work Risk of injury Physical activity Sleep deficiency Psychological distress Nelson et al 2014; Reme et al 2014; Sabbath et al 2014; Sorensen et al 2011; Tveito et al 2014; Reme et al (in review).

25 Example analysis #1: Workplace bullying and mental health expenditures Research question: Do bullied workers have greater health plan expenditures on mental health diagnoses than non-bullied workers? Study captures both health costs to workers and economic cost to the employer

26 Mental Health Care Costs and Bullying (N = 841 hospital workers, 2012) 2-year mental health care costs $1,400 $1,200 $1,000 $800 $600 $400 $200 $0 $480 No Bullying $796 $714 $1292 one type 2 types 3 types Sabbath et al (in review). Types: *Being ignored/excluded Being humiliated/ridiculed Withholding information

27 Example analysis #2: Safe patient handling and mobilization program Hospital A implemented a hospital-wide safe patient handling program as an integral part of a patient mobilization initiative in 2013; Hospital B did not Analysis uses survey data, injury database, and knowledge of policy implementation

28 Hospital-Wide Safe Patient Handling and Mobilization Program (SPH&M) Program Evaluation of SPH&M aimed at changing work practices to improve patient recovery through early mobilization while improving worker safety 8-month intervention: Increase equipment use and improve procedures to support patients plans of care Engage multiple departments with upper management support Enforce hospital-wide SPH policy Hospital-wide communications by upper management Training mandated by upper management Coordination of efforts across departments Investment in equipment

29 Finding: Significant reduction in lifting and exertion injuries Hospital A (Intervention) Hospital B (Control) 12-Months Pre-program (n=2149) 12-Months Post-program (n=2131) Lifting/ exertion injury count Rate/ 100 FTEs 95% CI Lifting/ exertion injury count Rate/ 100 FTEs 95% CI Rate Ratio 95% CI Using survey data, found changes in patient handling practices in intervention hospital, but not in control hospital Dennerlein JT, O'Day E, Mulloy DF, et al. (2017) Lifting and exertion injuries decrease after implementation of an integrated hospital-wide safe patient handling and mobilisation programme. Occup Environ Med. 74,

30 Conclusions and knowledge gained from these studies Practice: importance of addressing the psychosocial work environment to impact downstream costs Policy: efficacy of SPH&M programs in reducing worker injury

31 Evidence highlights Organizations using an integrated approach find it: Improves financial market performance 1 Leads to safer workplaces 2-3 Boosts productivity & worker satisfaction 4 Reduces absenteeism & lowers turnover rates 4-5 Bolsters employee participation 6 Creates stronger health & safety programs 7 Improves health-related behavior change Fabius, R., et al., Tracking the market performance of companies that integrate a culture of health and safety: an assessment of corporate health achievement award applicants. J Occup Environ Med, (1): p Shaw, W.S., et al., Employee perspectives on the role of supervisors to prevent workplace disability after injuries. J Occup Rehabil, (3): p Shaw, W.S., et al., A controlled case study of supervisor training to optimize response to injury in the food processing industry. Work, (2): p National Institute for Occupational Safety and Health, Total Worker Health: Making the Business Case Pronk, N., D. Lagerstrom, and J. Haws, LifeWorks@ TURCK: A Best Practice Case Study on Workplace Well-being Program Design. ACSM's Health & Fitness Journal, (3): p Hunt, M.K., et al., Process evaluation of an integrated health promotion/occupational health model in WellWorks-2. Health Educ Behav, (1):p LaMontagne, A., et al., Assessing and intervening on OSH programmes: effectiveness evaluation of the Wellworks-2 intervention in 15 manufacturing worksites. Occup Environ Med, (8): p Sorensen, G., et al., A comprehensive worksite cancer prevention intervention: behavior change results from a randomized controlled trial (United States). Cancer Cause Control, (6): p Pronk N, Integrated worker health protection and promotion programs. J Occup Environ Med, (Suppl)(12): p. S Anger, W.K., et al., Effectiveness of Total Worker Health interventions. J Occup Health Psychol, (2): p

32 Special considerations for low-wage workers Implications of low wages (e.g., quality of life, second job) Job quality: Working conditions Health and safety protections Job security Reliability and predictability of work hours Work intensity/pace Benefits Breaks/paid vacations Opportunities for career development Autonomy

33 How can this approach tie into what you are already doing? Where does this fit in your existing priorities?

34 How? Implications for Practice

35 A THOUGHT EXERCISE FOR YOU What s your pain point? What are the root causes in working conditions for your pain point? Policies, Programs, Practices Effective mechanical lift plan Working conditions Moving heavy items Employee & employer outcomes Reduce back injuries & costs What organizational strategies, such as policies, can improve these working conditions? Focuses on improving working conditions to improve employee and employer outcomes

36 Key Characteristics Leadership commitment Policies, programs & practices focused on positive working conditions 3. Participation 4. Comprehensive & collaborative strategies 5. Adherence 6. Data-driven change

37 Factors Contributing to Successful Implementation Leadership support Openness to change and innovation Dedicated resources (e.g., staff, budgets, and committees) Existing organizational processes Collaborative organizational cultures Prioritizing employee health and safety Leverage alignment with existing business priorities Realistic timelines

38 Addressing Potential Challenges Adequate preparation Knowing your organization, its people, and why they should care Involving all stakeholders in the planning process Listening to and addressing people s concerns Communicating often about what you re doing Realistic expectations and timelines

39 RESOURCES

40 The Guidelines Executive Summary Leadership & Collaboration Planning Implementation Evaluation & Improvement Tools & Resources Includes case examples, tips, checklists

41 Other resources on our website

42 Work, Health, and Well-being: Frameworks, Evidence, and Applications April 18-20, 2018 Boston, MA Hands-on, applied program Provides the knowledge and skills needed to improve workplace health and safety programs Ideal for anyone with direct responsibility for employee health, safety, or wellness For more information or to register:

43 Conclusions: Considerations for Organizations Improving working conditions adds value for employees and the bottom line. Align with your business priorities and ways of getting things done. Start with your own root causes build success in small steps. Consider a systems approach to build a sustainable culture of health.

44 Thank you!...and Questions? Our Shared Goal: Protect and promote worker safety, health, and well-being A Total Worker Health Center of Excellence Funded in part by grant U19OH from the CDC/NIOSH