Barcelona, 23-25 April 2014 HOW CAN LEADERSHIP AND TRAINING CONTRIBUTE TO A HEALTH PROMOTING ORGANISATIONAL CULTURE? Consol Serra, MD PhD Occupational Health Service, Parc de Salut MAR CiSAL - Centre for Research in Occupational Health, University Pompeu Fabra Workplace health promotion Group, Catalan Network HPH Barcelona, Spain
The changing nature of world of work: positive effects of work on health The longer you work, the longer you live Change of paradigm of occupational health: maintaining people at work! Van der Noordt M, et al. Health effects of employment: a systematic review of prospective studies. Occup Environ Med. 2014 Feb 20. [Epub ahead of print] Butterworth p, et al. The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey. Occup Environ Med. 2011;68:806-12
The costs of an unhealthy workplace Source: Shain M, Kramer DM. Occup Environ Med 2004;61:643 648
Health, life styles and working conditions of physicians in Catalonia, 2007 Psychosocial risk factors Support supervisor Psychological demands Control Support from peers Participation (men) (women)
Environmental and individual factors Perceived stress, behaviour, and BMI among adults participating in a worksite obesity prevention program, Seattle, 2005-2007. Barrington WE, et al. Prev Chronic Dis. 2012;9:E152. Potential role of everyday stress in dietary, eating, and physical activity behaviors. The association of perceived stress and these behaviors is likely greater in people who have higher levels of stress.
Health promotion in the workplace First philosophy, workplace as a venue (opportunity): individual behaviour and responsibility Examples: fitness, stress management, smoking cessation, back care, weight reduction/nutrition, medication. Second philosophy, workplace as an influence on health in its own: environment and individual The organisation and design of work in both its physical and psychosocial dimensions. Luxembourg declaration,1997. Source: Shain M, Kramer DM. Occup Environ Med 2004;61:643 648
Health promotion in the workplace Forces acting on health and productivity in the workplace, general picture : interaction What EMPLOYEES bring with them to the workplace in terms of personal resources, health practices, beliefs, attitudes, values, and hereditary endowment. What the WORKPLACE does to employees once they are there in terms of organisation of work in both the physical and psychosocial sense. Source: Shain M, Kramer DM. Occup Environ Med 2004;61:643 648
Environmental and individual factors Sorensen G, et al. Cancer Causes and Control 13: 493 502, 2002 HP/OHS final HP final OR p n 365 319 Smoking quit rate 11.8 5.9 2.13 0.04
Promoting health at work: what does it mean? Improving working conditions Promoting healthy lifestyles Managing individual cases Impact on disability and unemployment
Promoting health at work: what do we need? Resources, investments Expertise, competencies Legal frame and specific legislation ORGANISATIONAL CULTURE: involvement at all levels top management (chief executive, directors) line managers (supervisors, heads, etc.) workers and their representatives occupational health & safety experts others: technology, finances, HR, kitchen, etc. The product of individual and group values, attitudes, perceptions, competencies and patterns of behaviour that determine the commitment to, and the style and proficiency of, an organisation s health promotion climate (adapted from Flin 2006).
Safety climate and compliance with universal precautions Gershon et al. Am J Infect Control 2000 Table 6. Multiple logistical regression of safety climate sub-factors with exposure incidents as the outcome. OR (95% CI) Managerial support 0.56 (0.38-0.81) Feedback and training 0.42 (0.21-0.82)
Health promotion in the workplace Management and leadership Training to build capacity Managers and Employees Self-managed work teams
Health promoting LEADERSHIP MANAGEMENT INVOLVEMENT IN HP Programme design prerequisites are necessary but not sufficient, it needs: Management support Ensuring that employees understand and feel employer s commitment to the protection and promotion of employees wellbeing. Managers give employees possibilities for different health promotion activities. Supportive management climate: Organising work in ways that promote rather than defeat health and safety. Work is managed in a way that is health promoting for employees. Source: Shain M, Kramer DM. Occup Environ Med 2004;61:643 648
Health promoting LEADERSHIP Employee engagement and NHS performance Michael A West and Jeremy F Dawson, 2012
Health promoting LEADERSHIP Review on leadership and management in the aged care sector Jeon H-E, et al. Australasian Journal on Ageing. 2010; 29:54 60 Leadership is a hallmark of effective management. Leadership skills can be developed through targeted management training and mentorship. Effective leadership is integral to workforce retention and quality care delivery. Health-Promoting Leadership Andrea Eriksson. Doctoral thesis, Nordic School of Public Health. Sweden, 2011 Management = formal systems and concrete issues (goals setting, plans, cultural values, common assumptions) Leadership = unknown, informal systems, humans relations and organising people, changes and new systems, values, culture. Transformational, transactional.
Health promoting LEADERSHIP Occup Environ Med 2009; 66: 51-55. Good leadership: Support Communication Negotiation Empowerment Participation Team unity
Health promoting LEADERSHIP... and, what is leadership in health promotion? Health-promoting leadership concerns with creating a culture for healthpromoting workplaces and values that inspire and motivate employees to participate in such development. It means organising HP activities, supportive leadership style and developing a HP workplace. It is a critical part of organisational capacity for HP, including managerial knowledge and skills, organisational policies and structures. Requires support to managers, training, focused programs and action plans. Associated to positive effects on employees health, satisfaction and productivity. Source: Eriksson A. Health-Promoting Leadership. Doctoral thesis, Nordic School of Public Health, Sweden 2011.
Health promoting LEADERSHIP Review of the knowledge base on healthy worksite culture Aldana S, et al. J Occup Environ Med. 2010; 54:414-9. Improvement in employee health risk and level of leadership support
Health promoting LEADERSHIP Assessing management support for worksite health promotion: Leading by example (LBE) scale developed by Partnership for Prevention; modified and validated by Della LJ, et al. AJPH 2008 Leading by example 1. Take responsibility 2. Be truthful 3. Be courageous 4. Acknowledge failure 5. Be persistent 6. Create solutions 7. Listen 8. Delegate liberally 9. Take care of yourself 10. Roll up your sleeves
Health promoting LEADERSHIP Della LJ, et al. Am J Health Promot. 2010;25:138-146 Moderate-intensity intervention: access to healthy food and physical activities High-intensity intervention: + management/leadership support to increase health promotion climate (communication, leadership encouragement (goals, reward, training) (Estimated means across three factors of the LBE instrument) Intervention intensity Moderate High 1. Awareness of economics of health and productivity 3.01 3.14 2. Worksite support for health promotion 3.24 3.43 3. Leadership support for health promotion 3.47 3.57
The process of organisational culture The HSE culture stepladder. Source: European Agency for Safety and Health at Work, 2011. Occupational Safety and Health culture assessment - A review of main approaches and selected tools.
TRAINING to promote health at work Training has immediate effects on knowledge, attitudes, behaviour. These outcomes eventually affect behaviours and hazards, which in turn impact outcomes at the longer term (injuries, illnesses). Determined by training, trainees and workplace environment. Source: Conceptual model of workplace training interventions for primary prevention in OHS. Robson LS et al. 2012
TRAINING to promote health at work A controlled trial of an educational program to prevent low back injuries Daltroy LH, et al. The New England Journal of Medicine, 1997
Training: scientific evidence from systematic reviews MSK and ergonomics: Brewer S, et al. Workplace interventions to prevent MSK and visual symptoms and disorders in computer users. J Occup Rehab, 2006. Brewer S, et al. Injury/illness prevention and loss control programs. IWH, 2007. Martimo KP, et al. Training and lifting equipment for preventing back pain in lifting and handling. Br Med J, 2008. Kennedy CA, et al. Role of OH&S interventions in the prevention of upper extremity MSK symptoms, signs, disorders, injuries, claims and lost time. J Occup Rehab, 2010. Effectiveness of training on health and other outcomes Cohen A, et al. Assessing occupational health and training. NIOSH, 1998. Burke MJ, et al. Relative effectiveness of worker safety and health training methods. Am J Public Health, 2006. Robson LS, et al. Effectiveness of occupational health and safety training. IWH, 2012.
A systematic review of the effectiveness of occupational health and safety training Lynda S Robson, Carol M Stephenson, Paul A Shulte, Benjamin C Amick III, et al. Institute of Work and Health, Toronto (Canada). Review team: Canada and USA. Included studies = 22 Source: Scand J Work Environ Health. 2012; 38:193-208
Robson LS, et al. Institute of Work and Health, Toronto (Canada), 2012 Workplace education and training programs is recommended. Positive impact on the OHS behaviours of workers. However, no impact on health was shown (reducing injuries, symptoms). Not enough high quality studies to make recommendations about the nature or type of training, such as the level of engagement, computer versus lecture training or the number of sessions. Source: www. http://www.cdc.gov/niosh/docs/2010-127/pdfs/2010-127.pdf
CONCLUSIONS Hospitals and health services are health producing companies and should contribute to the benefits on health of having a job, to maintain health care workers at work and reduce turnover. Organisational culture to promote health at work is essential also in the healthcare sector. Good managers and leadership, and good and appropriately focused training are key elements to accomplish that goal. CULTURE organisation LEADERSHIP manager TRAINING employee
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