“Healthy Workplaces: Tips and Tools for a Comprehensive Approach” Regional Network Workshop Spring, 2003
Purpose: Goals • Pilot materials & approaches developed during first 2 years of the THCU Workplace Project. • Increase understanding & value of a comprehensive approach to workplace health. 3. Increase capacity to facilitate or function within CHPWI’s. 4. Increase capacity to work productively as a regional system, as indicated.
Purpose:Learning Objectives By the end of the workshop, participants will be able to: • Identify the evidence-based components of a comprehensive approach to workplace health promotion • Apply a series of tools geared to the promotion, planning, implementation and evaluation of a comprehensive workplace health promotion program • Access supports available to them in their workplace health efforts
Housekeeping Telephones Washrooms Lunch arrangements Participant Lists Other comments / questions?
Process: AGENDA • Welcome, Introductions & Housekeeping • Conceptual Overview • Element: Internal Project Management • Element: Situational Assessment • Sharing Time • Element: Making the Case • Toolboxes of Resources • Additional Supports • Project & Workshop Evaluation • Closure
PEOPLE:Group Introductions • Group according to the characteristic provided • Once in smaller group, introduce yourselves • organizational affiliation • how long in current role • how many workplaces do you work with at any given time? • what approach do you take?
The THCU Workplace Project • Funded through the provincial Stroke Strategy • In Year 3 • “Supporting Comprehensive Workplace Health Promotion in Ontario” • Web site (www.thcu/Workplace/Workplace.html) • Virtual community space • 5 regional pilot workshops • Follow-up consultations • Support to regional networks • The future …
Sharing Time Opportunity to: • share an innovative or interesting idea with colleagues • Ask questions of participants and facilitators regarding any workplace health challenge your are facing Anyone interested in a 5-10 minute slot?
Conceptual Overview “THCU’s Workplace Project Approach to Workplace Health Promotion” (v4.1.feb.4)
Process • As this information is shared, make notes of any questions or comments that come to mind • We will share & post these at the end of this section • Many may be addressed throughout the workshop but, if not, we will re-visit at the end of the session
CWHP … • is not consistently defined • is a “setting” in which to DO health promotion • is a key “determinant of health”
Occupational Health and Safety • Efforts to reduce physical and chemical hazards and ultimately injury, illness and disability. Includes: • Ergonomics • Injury prevention • Hazard identification and control • Emergency response programs • Disability case management • Medical services
Occupational Health and Safety • Emerging Issues • video display terminals • violence in the workplace • “sick building syndrome” • WSIB Best Practices in Prevention approach • others???
Voluntary Health Practices Includes lifestyle behaviour changes such as: • Smoking • Physical activity • Nutrition Some evidence of short-term changes in individual behaviour & improvements in productivity BUT health status is not necessarily positively affected.
Four Types of Health Promotion Strategies • Awareness Building: • Tell them there is risk of X. • Education/Skill Building: • Tell them / teach them ways to deal with X. • Environmental Support: • Create an environment that makes it easier for them to deal with X. • Policy Development: • Develop policies that reduce the risk or make it easier to deal with X.
Organizational Change • Not as widely accepted as part of workplace health promotion, compared to OH&S and voluntary health practices. • Challenging to implement, but related to effectiveness of voluntary health practice and occupational health and safety interventions.
Organizational Change • Typically meant to increase job satisfaction and ultimately productivity • Recent research has shown that many productivity precursors are closely related to health Cardiovascular disease & stroke Job control & workplace stress Job satisfaction
Contributing Factors • Keeping demands on time and energy within reasonable bounds • Maximizing employee participation in governance of their work • Providing adequate recognition • Terms of employment (amount paid, job security) • Corporate responses to non-work demands (e.g. child care) • Employer fairness • Peer & supervisory communication & feedback
Demand Time to do my work Effort Mental fatigue Control Involvement in decisions Reward Reward for level of effort Key Work Environment Factors in Job Stress and Satisfaction
The “Fairness” Connection XDemand XControl XEffort XReward Perceived to be Fair Perceived to be Unfair Management Practices
3 Main Strategies for Reducing Work-Related Stress 1. Alter the working conditions so that they are less stressful or more conducive to effective coping. This strategy is most appropriate for large numbers of workers working under severe conditions. Examples include altering physical annoyances such as noise levels, or changing organizational decision-making processes to include employees. Lazarus (1991): THE EDUCATIONAL RESOURCES INFORMATION CENTER
3 Main Strategies for Reducing Work-Related Stress 2. Help individuals adapt by teaching them better coping strategies for conditions that are impossible or difficult to change. A limitation to this strategy is that it is costly to deal with each individual's unique transaction with the environment. Intervention strategies could include individual counselling services for employees, Employee Assistance Programs, or specialized stress management programs, such as cognitive behavioural interventions (Long, 1988).
3 Main Strategies for Reducing Work-Related Stress 3. Identify the stressful relationship between the individual or group and the work setting. Intervention strategies might include changes in worker assignment to produce a better person-environment fit, or it could involve teaching coping strategies for individuals who share common coping deficits (e.g., training in relaxation skills).
Workplaces could … • align workloads with capabilities • define work roles and responsibilities very clearly • increase decision making • increase communication • increase access to resources needed to do the job • decrease job uncertainties • encourage networks of social support • promote meaningful jobs that allow workers to use their skills . . . cont’d
Workplaces could also … • provide flexible schedules • provide readily available, high quality child care • provide elder care support • enforce sexual harassment policies • be intolerent of gender discrimination • Provide professional / skill development • supplementary health benefits (e.g. dental)
Occupational Health and Safety Voluntary Health Practices Organizational Changes Awareness Building e.g. raise awareness about risks for repetitive strain injuries due to low pa. e.g. raise awareness via newsletter about the benefits of being physically active e.g. raise awareness about importance of providing input to management about job stress Education/ Skill Building e.g. training on how to handle heavy machinery e.g. assist employees set small, realistic PA goals. e.g. provide information on best ways to give feedback to management. Environ-mental Support e.g. provide necessary safety equipment e.g. provide fitness facilities in the workplace. e.g. providing child care facilities. Policy Develop-ment e.g. mandate rigorous assessment of equipment before use by employees e.g. allow employees to flex time to exercise at lunch hour. e.g. policies that allow employees a certain amount of work-time each year to pursue PD
Intersection of the 3 Approaches ·Cancer is frequently discussed under the heading of lifestyle issues, but is also an OH&S issue since many workplace chemicals and other hazards may contribute to cancer. ·Stress, one of the most common workplace ailments crosses all three categories. Though some lifestyle changes such as increased physical activity may help with stress, it may not decrease significantly unless the cause of stress, perhaps a hazardous work environment or an unwieldy workload, is removed.
Intersection of the 3 Approaches (2) ·Shift work may make it difficult for workers to get adequate sleep, eat regular meals, or to participate in exercise classes. ·Particular work environments encourage unhealthy alcohol consumption, including drinking and eating as part of client seeking and marketing in service and sales work.
Evidence for this Approach • Evidence of Effectiveness
Effectiveness • Despite the many complexities and confounding variables, there is reason to believe that comprehensive workplace health can be worthwhile regardless of whether you are most interested in increasing company profits or improving population health quality of life. • Can, that is, if it is truly comprehensive, including occupational health and safety, voluntary health practice and organizational change approaches.
Occupational Health and Safety • In the past 25 years, OH&S efforts have resulted in significant decreases in work-related fatalities, decreased exposure to toxic substances and increases in worker’s ability to control their environment. • Successes in this area have been built on a combination of efforts involving education and legislation.
Occupational Health and Safety • Recent studies suggest that work organization may have a broad influence on worker safety and health. • Workplace stress derived from measures of safety hazards, overcrowding, cognitive and physical demands, and environmental stressors can be used to predict occupational injuries.
Occupational Health and Safety • In addition to the relationship between OH&S and OC, there is also a relationship between the voluntary behaviour change approach and OH&S. • It has been found that employees with both high lifestyle risks and job risks were most likely to report injuries.
Voluntary Health Practices • There are many different ways to measure the effectiveness of these activities including: • process measures such as participation levels and employee satisfaction; • short term outcome measures such as behaviour change; • midterm outcome measures such as blood pressure or cost benefit; • long-term outcome measures such as morbidity and mortality.
Cost Benefit • Many review articles show that efforts within the personal lifestyle behaviour change approach can save employers money, largely by decreasing employee medical costs and absenteeism. • Depending on how you measure cost benefit, results show cost benefit ratios of between 1:3 and 1:4.
Cost Benefit: gaps and questions • Difficult to pinpoint exact cause of cost savings. Have health risks decreased? Or is perceived employer support making the difference? • Each case study varies enormously in terms of implementation strategy. It is hard to draw conclusions, particularly without information on the corporate context (culture). • Health Canada offers a good source of CDN data & limitations
Example of Conclusions: O’Donnell • Hypertension reduction efforts resulted in success rates of 60% to 85% while programs are in place. • Stress management programs have been shown to help with anxiety and muscle tension, but not with blood pressure, depression, irritability or sleep issues. • Weight control programs revealed some short-tern effectiveness, but not long-term effectiveness. • It was difficult to draw conclusions about nutrition and cholesterol interventions because the types of approaches varied widely.
Example of Conclusions: O’Donnell • Exerciseprograms were shown to reduce body fat and body mass and improve aerobic power, muscle strength, and flexibility during the program but long-term outcomes remain unknown. • Since the research done on workplace alcoholinterventions has been of poor quality, little can be concluded. • Programs addressing HIV/AIDS measured nothing about behaviour change, but did show an increase in knowledge and/or attitude changes.
Example of Conclusions: O’Donnell • More broadly found that programs which included an individual counseling component were twice as likely to be effective as those which did not include counseling. • Also, programs that included a combination of information, skill building and organizational enhancements were slightly more likely to have ‘mostly positive outcomes’ than programs that did not include all three of these approaches.
Voluntary Health Practices:Larry Chapman “According to the most recent scientific data available, piecemeal lifestyle initiatives may provide short term benefits, particularly as it relates to how employees perceive their employer, they have demonstrated little or no impact whatsoever on employee health over the longer term.”
Effectiveness of Organizational Change • Organizational factors such as job demands, control, rewards and the presence (or absence) of policies that assist with work-life balance do have a direct impact on mental and therefore physical health. • Job control in particular is associated with risk of cardiovascular disease. • Organizational factors have also been shown to be important in occupational health and safety efforts.
Effectiveness of Organizational Change • The literature suggests a spillover effect from job to leisure, indicating that people who hold stimulating jobs might be more likely to engage in physical activity and other healthy behaviours.
Effectiveness ofOrganizational Change • The risks associated with organizational factors and stress cannot be offset simply by stress management programs. • Shain has argued clearly for organizational change as a key ingredient in workplace health promotion. He states that health promotion programs will be effective only under conducive managerial conditions; conducive managerial conditions are primarily those that stimulate employee job satisfaction.
Effectiveness of Organizational Change • The effects of organizational change interventions, however, can be variable. • Numerous studies indicate that when management chooses to find ways of increasing employee control and reward, the benefits can be expected to decrease rates of almost all related adverse health outcomes. • A review by Polanyi reported that in some studies organizational change increased psychological workload and absenteeism, while in others it was related to decreases in burnout and emotional strain.