Advancing Well-Being Through Total Worker Health

Transcription

1 Advancing Well-Being Through Total Worker Health 2016 Pilot Research Project Symposium University of Cincinnati Keynote Address October 13, 2016 Anita L. Schill, PhD, MPH, MA Senior Science Advisor, Office of the Director Co-Manager, Total Worker Health Program National Institute for Occupational Safety and Health The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health, and should not be construed to represent any agency determination or policy.

2 My Goals For Today To stimulate new ways of thinking about how work impacts the health, safety and well-being of workers To inspire new research questions to be asked and answered to address our knowledge gaps 2

3 Why do we work? Work is about a search for daily meaning as well as daily bread, for recognition as well as cash, for astonishment rather than torpor, in short, for a sort of life rather than a Monday through Friday sort of dying. -- Studs Terkel, Working 3

4 MEANINGFUL WORK (MW) 4

5 Humans Seek Meaning Image Source: izquotes.com 5

6 What is it? Little consensus on the meaning of MW Work that employees believe is significant in that it serves an important purpose A subjective belief that one s work is significant When an individual perceives an authentic connection between work and a broader transcendent life purpose beyond the self Steger MF, Dik BJ, Duffy RD. (2012). Measuring Meaningful Work: The Work and Meaning Inventory. Journal of Career Assessment 20(3), , 323. In BJ Dik, ZS Byrne & MF Steger (Eds.). (2013). Purpose and Meaning in the Workplace. Washington, DC: American Psychological Association. Berg et al. Chapter 4, 81. Lent, Chapter 7, 153. Bailey C, Madden A. (2016). What Makes Work Meaningful Or Meaningless. MIT Sloan Management Review Summer 2016, 52-61, 55. 6

7 Subjective or Objective? Meaning in work amount of meaning people experience Meaning of work specific content of work that provides people with meaning 7

8 Meaningful Work is about... Optimal work experiences Beneficial synergies between work and the rest of life Finding work that resonates with the entirety of one s personality, values, and passions Dik BJ, Byrne ZS, Steger MF. (2013) Introduction: Toward an integrative Science and Practice of Meaningful Work. In BJ Dik, ZS Byrne & MF Steger (Eds.). Purpose and Meaning in the Workplace. Washington, DC: American Psychological Association. 8

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10 Morin EM, Presented at 10 th World Congress on Human Resources Management, Rio de Janeiro, Brazil, August 20,

11 Job Crafting Process of employees redefining and reimagining their job design in personally meaningful ways (Wrzesniewski & Dutton, 2001) Employees are actively involved in job design to create work that is meaningful to them Continuous process of bottom up job crafting of top down job design Berg JM, Dutton JE, Wrzesniewski A. (2013). Job Crafting and Meaningful Work. In BJ Dik, ZS Byrne & MF Steger (Eds.). Purpose and Meaning in the Workplace. Washington, DC: American Psychological Association.

12 Job Crafting Techniques 1. Task Crafting altering responsibilities, adding or dropping tasks; altering nature of tasks; changing time, energy, & attention allotment 2. Relational Crafting changing how, when and with whom employees interact 3. Cognitive Crafting changing perceptions of tasks and relationships Berg JM, Dutton JE, Wrzesniewski A. (2013). Job Crafting and Meaningful Work. In BJ Dik, ZS Byrne & MF Steger (Eds.). Purpose and Meaning in the Workplace. Washington, DC: American Psychological Association.

13 Job Crafting as a New Model Fixed job descriptions are becoming less common in the new economy Fosters innovation and flexibility Cultivates: Meaningfulness in work Job satisfaction Retention of productive employees Work engagement Berg JM, Dutton JE, Wrzesniewski A. (2013). Job Crafting and Meaningful Work. In BJ Dik, ZS Byrne & MF Steger (Eds.). Purpose and Meaning in the Workplace. Washington, DC: American Psychological Association.

14 Concept of Engagement... [E]mployees offer up different degrees and dimensions of themselves according to some internal calculus that they consciously and unconsciously compute. Employees move in and out of roles They move towards what matters to them Engagement is the bringing of one s self into something outside the self. Kahn, WA & Fellows S. (2013). Employee Engagement and Meaningful Work. In BJ Dik, ZS Byrne & MF Steger (Eds.). Purpose and Meaning in the Workplace. Washington, DC: American Psychological Association. 14

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16 What about the other 68% % Not Engaged 17.2% Actively Disengaged 16

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18 FISSURED WORKPLACES FRACTURED WORKERS 18

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20 New Economy Work Arrangements Standard Work Arrangements Permanent jobs with a traditional employer-employee relationship Fissuring Business models that obscure or eliminate the link between the worker and the employer; used to shield employers from responsibility for working conditions Nonstandard Work Arrangements ( contingent ) Work without traditional employers or regular, full-time schedules 20

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22 Alternative Work Arrangements Agency Temps Contract Company Workers Day Laborers Direct Hire Temps Independent Contractors On-Call Workers Self-Employed Workers Standard Part-Time Workers 22

23 Alternative Work Arrangements Affect Worker Health Low(er) Wage Lack of Health Insurance Lack of Paid Medical and Family Leave Job Insecurity Work Intensification Hazardous Jobs with Inadequate Training Mandatory Overtime Stressors from Work Itself 23

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25 Paid Sick Leave & Occupational Injury Does presence/absence of PSL impact injury rates? 28% lower injury likelihood for workers with access to PSL compared to workers without access to PSL, based upon data of working adults, National Health Interview Survey, Association varied across different industry sectors Introducing or expanding PSL might help businesses reduce the incidence of nonfatal occupational injuries More likely to lower risks in industry sectors or occupations with a high risk of injury Employers could save $16 - $56 billion per year or $375 - $1,300 per worker per year by offering PSL to their employees 25

26 Predicted Probability of Injury, % Predicted Probability of Nonfatal Occupational Injury by Access to Paid Sick Leave and Occupational Sector, NHIS No Paid Sick Leave Paid Sick Leave Asfaw A, Pana-Cryan R, Rosa R. Paid Sick Leave and Nonfatal Occupational Injuries. Am J Public Health. 2012;102:e59 e64. doi: /AJPH

27 Work Affects Life Expectancy Goh J, Pfeffer J, Zenios S. (2015). Exposure to Harmful Workplace Practices Could Account for Inequality in Life Spans Across Different Demographic Groups. Health Affairs 34(10):

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29 Punnett L and the Center for the Promotion of Health in the New England Workplace. Recent Trends and Research in Worker Safety and Health. February 25, 2014 NIOSH Total Worker Health Webinar. 29

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32 TOTAL WORKER HEALTH 32

33 Total Worker Health = A New Model You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. Richard Buckminster Fuller 33

34 Occupational Safety & Health Act... to assure so far as possible every man and woman in the Nation safe and healthful working conditions and to preserve our human resources... by developing innovative methods, techniques, and approaches... 34

35 TWH seeks to expand our understanding of health and to enlarge the contribution that NIOSH can make to overall worker safety, health and well-being. 35

36 What is Total Worker Health?.policies, programs, and practices that integrate protection from work-related safety & health hazards with promotion of injury and illness prevention efforts to advance worker well-being. 36

37 Keep Workers Safe Establish Workplace Policies, Practices, and Programs that Grow Health Create Worker Well-Being 37

38 What Total Worker Health Is NOT TWH is not a wellness program that has been implemented without simultaneously providing safe and healthful working conditions. TWH is not a collection of health promotion efforts at a workplace where the very way that work is organized and structured is contributing to worker injuries and illness. TWH is not consistent with workplace policies that discriminate against or penalize workers for their individual health conditions or create disincentives for improving health. TWH is not a wellness program that does not ask employees about what work factors they think are contributing to their stress. Adapted from Opening Keynote, John Howard, Director of NIOSH, October Bethesda, MD. 38

39 Issues Relevant to Advancing Worker Well-being Through Total Worker Health Control of Hazards and Exposures Chemicals Physical Agents Biological Agents Psychosocial Factors Human Factors Risk Assessment and Risk Management Organization of Work Fatigue and Stress Prevention Work Intensification Prevention Safe Staffing Overtime Management Healthier Shift Work Reduction of Risks from Long Work Hours Flexible Work Arrangements Adequate Meal and Rest Breaks Built Environment Supports Healthy Air Quality Access to Healthy, Affordable Food Options Safe and Clean Restroom Facilities Safe, Clean and Equipped Eating Facilities Safe Access to the Workplace Environments Designed to Accommodate Worker Diversity Leadership Shared Commitment to Safety, Health, and Well-Being Supportive Managers, Supervisors, and Executives Responsible Business Decision-Making Meaningful Work and Engagement Worker Recognition and Respect Compensation and Benefits Adequate Wages and Prevention of Wage Theft Equitable Performance Appraisals and Promotion Work-Life Programs Paid Time Off (Sick, Vacation, Caregiving) Disability Insurance (Short- & Long-Term) Workers Compensation Benefits Affordable, Comprehensive Healthcare and Life Insurance Prevention of Cost Shifting between Payers (Workers Compensation, Health Insurance) Retirement Planning and Benefits Chronic Disease Prevention and Disease Management Access to Confidential, Quality Healthcare Services Career and Skills Development Community Supports Healthy Community Design Safe, Healthy and Affordable Housing Options Safe and Clean Environment (Air and Water Quality, Noise Levels, Tobacco-Free Policies) Access to Safe Green Spaces and Non- Motorized Pathways Access to Affordable, Quality Healthcare and Well-Being Resources Changing Workforce Demographics Multigenerational and Diverse Workforce Aging Workforce and Older Workers Vulnerable Worker Populations Workers with Disabilities Occupational Health Disparities Increasing Number of Small Employers Global and Multinational Workforce Policy Issues Health Information Privacy Reasonable Accommodations Return-to-Work Equal Employment Opportunity Family and Medical Leave Elimination of Bullying, Violence, Harassment, and Discrimination Prevention of Stressful Job Monitoring Practices Worker-Centered Organizational Policies Promoting Productive Aging New Employment Patterns Contracting and Subcontracting Precarious and Contingent Employment Multi-Employer Worksites Organizational Restructuring, Downsizing and Mergers Financial and Job Security November 2015 Total Worker Health is a registered trademark of the US Department of Health and Human Services

40 New Employment Patterns Policy Issues Changing Workforce Demographics Organization of Work Control of Hazards and Exposures Compensation and Benefits Leadership Community Supports November 2015 Total Worker Health is a registered trademark of the US Department of Health and Human Services

41 Isn t Behavior Change Enough? It is unreasonable to expect people to change their behavior when the social, cultural and physical environments around them fully conspire against them. Adapted from M. Marmot/Institute of Medicine Report 41

42 Traditional Hierarchy of Controls 42

43 Hierarchy of Controls Applied to TWH 43

44 WORK AND WELL-BEING 44

45 WHAT IS WORKER WELL-BEING? RAND-NIOSH COLLABORATION 45

46 RAND: Operationalizing Well-Being How should well-being be defined in the context of TWH? What subjective & objective factors contribute to or diminish well-being? How does the changing nature of work, workforce demographics, employment patterns, & the porous workplace influence well-being? What measures will gauge success of the TWH approach? Which policies, programs & practices will be effective to protect, preserve & promote well-being? 46

47 Worker Well-Being Definition and Worker well-being is an integrative concept that characterizes quality of life with respect to an individual's health and workrelated environmental, organizational, and psychosocial factors. It is the experience of positive perceptions and the presence of constructive conditions at work and beyond that enables workers to thrive and achieve their full potential. Model Domains

48 Domain Definitions Domain Physical environment & safety climate Policy environment Health status Work evaluation & experience External context Definition Aspects of individuals lives relating to the physical features of the work environment that comprise their working conditions. Aspects of individuals lives relating to the organizational policy context in which they work. Aspects of individuals lives relating to their physical and mental health and welfare. Individuals experiences and evaluations of their working lives that comprise psychological wellbeing in the workplace context. Aspects of individuals lives that are situated outside of work yet contribute to overall wellbeing and thus may influence worker well-being

49 FUTURE RESEARCH

50 TWH National Occupational Research Agenda,

51 Strategic Goals 1. Research: Advance and conduct etiologic, surveillance, and intervention research that builds the evidence base for effectively integrating protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. 2. Practice: Increase the implementation of evidence-based 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. 3. Policy: Increase adoption of policies that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. 4. Capacity-Building: Build capacity to strengthen the TWH workforce and TWH field to support the development, growth, and maintenance of 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. 51

52 P2P Goals: 1. Identify research gaps & methodological & scientific weaknesses 2. Suggest research needs 3. Move the field forward through unbiased & evidence-based assessment P2P TWH Workshop: December 9-10, 2015 Dissemination & Follow-Up: 2016 & Beyond 52

53 Independent Panel Report 53

54 NIH Panel Recommendations 1. Convene a meeting of stakeholders to set research priorities for integrated interventions. 2. Develop a consensus-based conceptual framework to guide future intervention research. 3. Develop a core set of measures and outcomes that are incorporated into all integrated intervention studies. 4. Use a transdisciplinary and participatory process for intervention development. 54

55 NIH Panel Recommendations 5. Ensure that future intervention studies represent an appropriate range of worker populations and settings. 6. Expand research and evaluation design options to include a range of rigorous methodologies. 7. Develop effective strategies for timely dissemination of findings to a wide variety of stakeholders. 8. Make investments in research infrastructure and assets to develop population-based laboratories for TWH research. 55

56 Editorials on Panel Report 56

57 Examples of Critical Areas for Total Worker Health Research How do conditions of work define health and well-being outcomes, on and off the job? How can we find targeted interventions for the highest-risk or most vulnerable workers? How can healthier job design and work organization principles advance worker well-being? What are the health consequences of the current macro-economy, new employment patterns, the changing organization of work, dramatic shifts in worker demographics, and evolving healthcare schemes? What pro-health interventions can improve quality of life and health opportunity for workers? How do we optimize the well-being of our families and society through employment? How can we prevent or mitigate the harms arising from hazardous work schedules, psychosocial stress, and unhealthy supervision? How can we show the value of investment more clearly in TWH approaches?

58 Bottom Line We need to build the scientific evidence base to continue to support TWH policies, programs, and practices. 58

59 ADVANCING WELL-BEING THROUGH TOTAL WORKER HEALTH 59

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61 Maslow s Modified Hierarchy of Needs 61

62 Creating Space to Support the Journey to Wholeness Extraordinary things begin to happen when we dare to bring all of who we are to work. Every time we leave a part of us behind, we cut ourselves off from part of our potential... No wonder many workplaces feel somehow lifeless... In wholeness we are life-full. We discover in awe how much more life there is in us than we ever imagined... work becomes a vehicle where we help each other reveal our inner greatness and manifest our calling. Laloux, F. Reinventing Organizations. Brussels: Nelson Parker; Page 144.

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64 TWH Core Team 64

65 Connect with Us! Twitter LinkedIn (NIOSH Total Worker Health) TWH in Action! e-newsletter 65

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67 Consequences of Alternative Work Arrangements Work-Related Injury, Illness, Disease Worker might quickly be out of a job and, depending on the severity of the injury; prospects of new employment may be slim Without employer-based health insurance, costs of treating injuries are typically shifted to the worker or the public at large Employers who do not directly pay for workers compensation and health insurance may be insulated from premium adjustments based on the cost of workers injuries Employers of contingent labor may escape the financial incentives that drive decisions to eliminate hazards for other workers OSH Regulations Contingent workers may fall through the cracks of government safety and health regulatory enforcement

68 Physical Environment & Subdomains Benefits: Nonwage compensation provided to workers in addition to their normal salaries or wages Salary/rewards: A worker s normal salary and wages Work-life balance: Policies that support satisfactory prioritization between work and lifestyle Workplace practices: Extra amenities, programs, or services provided to workers Productive employment circumstances: Work environment promotes a culture of fairness, collegiality, and respect that is conducive to completing responsibilities effectively Anti-discrimination policies: Procedures are in place to protect against/enforce consequences for unfair worker treatment Safety Climate Subdomain Constructs Health and education benefits Dependent coverage for spouses/partners/children Health savings accounts and cash incentives Income that meets monthly needs Monetary rewards for job performance Non-monetary rewards including recognition and prestige Caregiving leave policies Flexible working conditions Vacation and paid time off policies Health and wellness programs Stress management and mental health programs Family friendly services (e.g., childcare, new mother resources) Community-focused programs (e.g., volunteer services) General amenities (e.g., onsite gym, kitchen) Fairness in workplace policies and practices (e.g., supervisory practices, promotion practices, fair income in relation to others) Effective and respected leadership Workers are treated with respect Polices exist to protect against ageism, sexism, and racism Workplace has standards of conduct guidelines

69 Policy Environment Subdomains Workplace safety conditions: Health and safety of working environment is up to standards Workplace design: Comfort, look, and feel of working environment Workplace safety protocols, standards, and trainings: The workplace has safety guidelines and communicates guidelines to employees Workplace conflict and violence: Negative acts directed towards a person at work or on duty Workplace-specific safety conditions: Occupationally distinct safety hazards Workplace safety awareness, perceptions, and attitudes: Workers perceptions of safety on the job Subdomain Constructs Electrical safety Fire safety Hazardous materials safety Equipment, furniture, and infrastructure safety IEQ: ventilation, dampness and mold, chemicals and odors Temperature Noise Lighting Protocols for safety procedures Protocols for reporting safety violations Experience of conflict or violence (harassment, bullying) Use of dangerous equipment Exposures to hazardous conditions or materials Satisfaction with safety program Management attitudes towards safety Sanitation/cleanliness Ergonomics Presence of safety resources (e.g., first aid supplies) Presence of security personnel and measures Accommodations for disabilities Workspace flexibility Flow and design of workspaces Status of safety committees/ safety officers Availability of safety training sessions Concern about conflict or violence Intensity of manual labor Knowledge and use of safety protocols Perceived importance of safety protocols, standards, and trainings

70 Health Status Subdomains Physical health: Overall status of biological and physiological functioning Mental health: Overall mental and emotional health status Health-related behaviors and lifestyle: Conscious health choices and actions taken by an individual Injuries: Bodily harm incurred from a working environment Functionality: Ability to participate in usual activities Subdomain Constructs General/overall health Presence of medical conditions Biological health (e.g., BMI, blood pressure, cholesterol) General/overall mental health Presence of mental health disorders (e.g., anxiety, depression) Experience of stress Physical activity Substance use (drugs, alcohol, tobacco) Sleep behaviors and patterns Nutrition and food behaviors Healthcare behaviors (e.g., screenings, regular doctor visits) Engagement in risky behaviors (e.g., drinking & driving) Type and degree of injury incurred on the job Overall physical or mental limitations Special equipment needs Difficulty talking, decision making, remembering, concentrating

71 Work Evaluation & Experience Subdomains Satisfaction: Positive feelings and attitudes towards one s job Subdomain Constructs Job satisfaction Affect: The subjective experience of positive and negative emotions towards one s job Meaning and sense of purpose: The presence of goals in life and a sense of directedness Relationships: The quality of interactions with people at work Anger/hostility Sadness Fear Happiness/joy Vigor Engagement Autonomy Growth Job involvement/purpose Thriving Flow Peers and coworkers Managers and supervisors

72 External Context Subdomains Overall life satisfaction: Worker s evaluation of their life as whole Organizational image/reputation: External perceptions of a worker s organization Social and familial relationships: The quality of interactions with personal contacts Financial health: Worker has achieved economic security Community engagement: Worker contributions and involvement within local institutions Lifestyle: Behaviors and values cultivated outside of work Spiritual health: Striving for transcendence beyond the here and now in search of some higher power/something greater than the self Subdomain Constructs Life satisfaction Perceived organizational motives Perceived organizational actions Job interference with family life Personal social support Relational satisfaction Ability to buy adequate food, shelter, healthcare, and medicine Income is able to meet habits/bills Geographical or community satisfaction Geographical or community improvement/deterioration Memberships in community organizations Engagement in leisure activities Reason for living Peace of mind Sense of purpose Comfort in faith or spiritual beliefs Strength in faith or spiritual beliefs