TWH™ in Action!

Volume 2 Number 4 November 2013

Managers’ Buzz

BY:ANITA L. SCHILL, PhD, MPH, MA AND L. CASEY CHOSEWOOD, MD

Who is responsible for worker health? Workers? Employers? Healthcare providers? Government? Everybody? Nobody? These are the questions that Dr. John Howard, NIOSH Director, used to provocatively challenge the audience at the 27th National Conference on Health, Productivity and Human Capital hosted by the National Business Group on Health, September 25 – 27 in Washington, D.C. According to Dr. Howard, national economic health hinges upon the health of our workforce which is threatened by pervasive issues, such as obesity, diabetes, chronic obstructive pulmonary disease (COPD), and aging. His bottom line: worker health is economic health. Keeping workers healthy and productive contributes to quality of life, local and national economies, and reduces the burden on entitlement programs such as social security disability insurance, social security, and Medicare.

The NIOSH TOTAL WORKER HEALTH^® (TWH) Program aims to advance worker safety, health and well-being by integrating workplace approaches to health protection and wellness promotion. As our thinking about this program has evolved Dr. Howard shared his expanded vision for the program in the context of worker health driving economic health. He envisions the program will:

• Help to reverse the alarming threats to population health by concentrating on the proportion of Americans who are workers.
• Develop an evidence-based prevention framework for total worker health—using an integrated approach to health protection and health promotion to achieve greater worker well-being.
• Promote and fund scientific research into what programs work best for which workers, employers, and shareholders.
• Promote understanding of total worker health to the worker, the worker’s family, the employer, the insurer and economic growth of the Nation.

This issue of TWH^® in Action! contains glimpses of the work being done by NIOSH and our colleagues and stakeholders to fulfill the aims of the Total Worker Health Program. Read about the Third Annual National Expert Colloquium convened by NIOSH on September 19. The Colloquium was attended by 17 national leaders from academia, industry, and labor. The full story about this inspirational meeting can be found in Updates from the NIOSH TOTAL WORKER HEALTH^® Program.

In TOTAL WORKER HEALTH^® Exclusive, learn the latest on organizational assessment tools for Total Worker Health as Dr. Deborah McLellan and her colleagues share existing and emerging ways to measure integrated approaches to worker health protection and promotion. In Healthier Feds, find out how the federal government is promoting cardiovascular health among their employees through its FedStrive Initiative. Learn more about ground-breaking TWH research in Updates from NIOSH Centers of Excellence to Promote a Healthier Workforce.

Also in this issue, we celebrate a milestone for reaching over 500 professional members in our NIOSH Total Worker Health LinkedIn Group. Established in September 2012 as a means to connect professionals from industry, government and labor on research and practice related to Total Worker Health, the group has members from all over the world. In the spirit of this celebration, we invite you to join us, if you are not a member, and if you are a member, we encourage you to invite your peers to join us.

As always, we hope this newsletter inspires you to become a Total Worker Health advocate. Share your comments and stories about TWH in Action! with us on Twitter (@NIOSH_TWH), on the NIOSH Total Worker Health LinkedIn Group, or send us an email at TWH@cdc.gov.

TOTAL WORKER HEALTH^® Exclusive

Emerging efforts to measure Total Worker Health

BY:DEBORAH MCLELLAN PHD, MHS; RESEARCH SCIENTIST, DANA-FARBER CANCER INSTITUTE AND THE HARVARD SCHOOL OF PUBLIC HEALTH CENTER FOR WORK, HEALTH, AND WELL-BEING; HEIDI HUDSON MPH; PROGRAM COORDINATOR, TOTAL WORKER HEALTH, NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH; GLORIAN SORENSEN, PHD, MPH, PROFESSOR, HARVARD SCHOOL OF PUBLIC HEALTH, PRINCIPAL INVESTIGATOR, HARVARD SCHOOL OF PUBLIC HEALTH CENTER FOR WORK, HEALTH, AND WELL-BEING, DIRECTOR, CENTER FOR COMMUNITY-BASED RESEARCH, DANA-FARBER CANCER INSTITUTE

The NIOSH TOTAL WORKER HEALTH^®(TWH) Program is built upon growing evidence indicating comprehensive policies and programs that concurrently address health promotion and health protection may be more effective in preventing disease and promoting health and safety than either approach alone. This integrated approach has been endorsed by the American College of Occupational and Environmental Medicine, the American Heart Association for cardiovascular health promotion, the International Association for Worksite Health Promotion, and the Institute of Medicine.

Despite its broad support, no shared definition or set of standard evaluation metrics exist for integrated approaches. A common definition and consistent metrics would facilitate the adoption and dissemination of integrated approaches at worksites. While measures exist to assess safety climate, workplace health promotion, and a “culture of health,” they tend to focus on either health promotion or health protection rather than on their integration. Existing surveys also tend to be long and may not be practical for many businesses, especially small ones, to complete.

As some examples of existing tools, the Occupational Safety and Health Administration’s Form 33 contains questions about organizational programs and policies pertaining to occupational safety and health, but was not intended to assess workplace health promotion (available at: https://www.osha.gov/SLTC/etools/safetyhealth/form33i.html). The American College of Occupational and Environmental Medicine’s Corporate Health Achievement Award (available at: http://www.chaa.org/) has over 240 questions that include ones that could be considered as measuring integrated approaches, but it still lacks questions on the psychosocial work environment and stress. NIOSH’s Essential Elements of Effective Workplace Programs and Policies (available at /niosh/TWH/essentials.html),were developed to guide employers interested in conducting comprehensive approaches to worker health, but were not intended to be used as concrete measures of integrated approaches. The Harvard School of Public Health (HSPH) Center for Work, Health, and Well-being included in its SafeWell Practice Guidelines a scorecard (available at http://centerforworkhealth.sph.harvard.edu/) developed by HealthPartners Inc. that uses the NIOSH Essential Elements as an example of the type of practical tool that can be used by worksites. The SafeWell Practice Guidelines also identify specific assessments that may be used for planning integrated approaches that are sensitive to the needs and resources of different organizations.

In 2012, the Centers for Disease Control and Prevention in collaboration with the NIOSH developed a Worksite Health ScoreCard (HSC) (available at: /dhdsp/pubs/worksite_scorecard.htm). This employer-based assessment tool addresses multiple health topics including chronic disease prevention, workplace stress and immunizations. In 2013, the HSC expanded to include occupational safety and health and the worksite’s health culture with the aim of using it as part of a suite of tools available for the National Healthy Worksite Program (NHWP) (See /nationalhealthyworksite/index.html). Working to provide health protection expertise for NHWP subcontractors, the Center for the Promotion of Health in the New England Workplace (CPH-NEW) at the University of Connecticut assisted with development and analysis of organizational climate and culture surveys. Combined, this suite of tools can be used for measuring integration of health protection and health promotion.

Overall, the Centers of Excellence to Promote a Healthier Workforce, funded by NIOSH, are conducting a series of activities for moving forward in providing definitions, metrics, and tools for evaluating an “integrated” approach to worker health. In November 2012, over 120 people from 16 states convened at the Total Worker Health Symposium—Safe, Healthy and Cost-Effective Solutions sponsored by the University of Iowa’s Healthier Workforce Center for Excellence (slides available at www.hwce.org/twhsymposium) where the importance of shared metrics and evaluation were discussed. A special supplement to the Journal of Occupational and Environmental Medicine is currently in press which contains findings from the symposium. The supplement contains an article from the HSPH Center for Work, Health, and Well-being proposing a definition of integrated approaches to worker health, and key indicators and measures that may be used by employers and researchers to measure the extent to which integrated efforts are being implemented within an organization. For example, the extent of collaboration between functions responsible for worksite health promotion and occupational safety and health protection could be seen indicating the degree to which an organization is integrated.

The Centers of Excellence to Promote a Healthier Workforce recently hosted a session titled “Total Worker Health: Beyond conventional health promotion” on November 4, 2013 at the Annual Meeting of the American Public Health Association in Boston. Issues of measurement and evaluation were addressed and discussed. Additionally, the HSPH Executive and Continuing Professional Education Program will present a course on Work, Health, and Well-being: Integrating Wellness and Occupational Health and Safety in the Workplace to be held January 27 – 29, 2014 in Boston, MA (https://ecpe.sph.harvard.edu/programs.cfm?CSID=WHW0114). The course will address methods for assessing integrated approaches to worker health protection and promotion.

NIOSH and the Centers of Excellence continue to research and provide national resources and tools for integrated approaches to worker health and well-being. The TWH in Action! quarterly enewsletter, and NIOSH’s science blog will cover more of these in the upcoming months. Stay tuned!

Editors’ Note: The NIOSH intramural research program is addressing data gaps regarding the TWH approach by funding several new projects in this area. These projects are just getting underway, but one of the first steps for each of them is to plan how to measure the extent to which integrated programs exist within organizations participating in the studies. Measures that are under development range from guided interview questions to surveys that will be completed by key informants. For example, small businesses participating in the Ohio Bureau of Workers’ Compensation Workplace Wellness Grant Program have been completing an 11 question survey instrument to measure the integration of occupational safety and health programs with wellness programs; NIOSH will evaluate the instrument next year. Read more about this initiative in New Resources and Initiatives.

REFERENCES

1. Hymel PA, Loeppke RR, Baase CM, et al. Workplace Health Protection and Promotion: A New Pathway for a Healthier-and Safer-Workforce. J Occup Environ Med. Jun 2011;53(6):695-702.
2. Carnethon M, Whitsel LP, Franklin BA, et al. Worksite Wellness Programs for Cardiovascular Disease Prevention. Circulation. 2009;120(17):1725-1741.
3. International Association for Worksite Health Promotion (IAWHP). IAWHP’s Las Vegas Announcement on Worksite Health, March 27, 2012. 2012; http://www.acsm-iawhp.org/files/public/Las%20Vegas%20Announcement%20on%20Worksite%20Health%20Promotion%202012_Final.pdf. Accessed November 3, 2012.
4. Institute of Medicine. Integrating Employee Health: A Model Program for NASA: National Academies Press; 2005.
5. Sorensen G, McLellan D, Dennerlein J, et al. Integration of Health Protection and Health Promotion: Innovative Approaches to Worksite Health. Journal of Occupational and Environmental Medicine. in press.

Promising Practices for TOTAL WORKER HEALTH^®

In Promising Practices for TOTAL WORKER HEALTH^® we share with you examples of how employers from across the country and from a wide range of industries are taking steps to integrate both health promotion and health protection in their workplaces.

If your organization is proactively integrating health protection and health promotion to prevent injury and illness and advance the well-being of your workers, please email us at TWH@cdc.gov.

We need your help to improve Promising Practices for Total Worker Health!
Share your thoughts! We invite you to join us on LinkedIn and tell us how we can enhance our communications about ongoing promising practices across the country.

Healthier Feds

A growing body of scientific evidence indicates that the quality work environment is a predictor of health behaviors. In support of this notion, the federal government is providing opportunities for advanced health and well-being in its own workforce. The purpose of this section is to spotlight ways in which the federal community is improving the health and safety of federal employees.

Improving the Health, Safety, and Productivity of Our Federal Employees

BY:CONSTANCE FRANKLIN, MPA, PUBLIC HEALTH ANALYST, NIOSH; LCDR JYL C. WOOLFOLK, MPH, CHES, ASSOCIATE DIRECTOR, FEDSTRIVE; AND, DAMON THOMPSON, DIRECTOR OF THE CENTER FOR HEALTH COMMUNICATIONS, FEDERAL OCCUPATIONAL HEALTH

At a time when most federal agencies are being asked to “do more with less,” Federal Occupational Health (FOH) helps by providing services designed to improve the health, safety and productivity of federal employees. A part of the U.S. Department of Health and Human Services (HHS), FOH works in partnership with federal agencies and organizations across government to design and deliver solutions that meet their occupational health needs.

As the largest provider of occupational health services in the federal government, FOH serves more than 360 agencies and reaching 1.8 million federal employees. FOH’s clinical, work/life, and environmental health services aims to help agencies increase productivity by reducing the time that employees spend away from work on visits to the doctor’s office or dealing with personal issues.

In 2009, President Obama hosted a business roundtable with major corporate leaders to examine how they were driving down employee health and wellness costs. The common theme that emerged from those discussions was that the private sector achieved success through an emphasis on strong, on-site health and wellness programs. Investing in prevention, these corporate giants saw a decrease in measures like emergency room visits, and inpatient and outpatient care, along with an increase in the services that they offered onsite.

FedStrive

That discussion then turned to an examination of how such services were being offered within the federal government. As a result, in November 2009, HHS Secretary Kathleen Sebelius announced the creation of FedStrive – an FOH program that provides health, wellness, and work/life services through an comprehensive approach to assist agencies in establishing a culture of health and high performance.

One of the keys to this data-driven approach is the Health Risk Appraisal (HRA), a survey that helps FedStrive participants identify their potential health risks through a review of their lifestyle practices and family health histories. The results allow employees to set their own health goals, while FedStrive staff can guide them to services that help them meet those goals.

FedStrive was launched as a pilot project in 2010.Within the first two-and-a-half years, the program saw an increase in the number of employees who completed the HRA, as well as reductions in unhealthy behaviors, risk factors, cholesterol levels, and weight.

At that point, the program was extended to federal employers nationwide, with an initial concentration on regional centers where HHS has a strong presence. As of December 2013, FedStrive will have been formally launched in 10 HHS Regions. However, any federal agency that has an agreement with FOH is eligible to opt for FedStrive.

“FedStrive Virtual” is a recently launched option that gives employees access to an online Health Risk Appraisal, as well as lifestyle coaches available by telephone. This allows employees located in different areas the flexibility of being served without having to physically enter a wellness center to get assistance. This approach is currently being implemented for Veteran’s Administration 350,000 employees.

Primary Goals of FEDstrive:

• Keep low risk behaviors at low risk
• Reduce high risk behavior risk factors among moderate to high risk populations
• Provide evidence-based health promotion programming from HRA data
• Contain costs to effectively allocate resources

Incentives – Organizational Leadership

While financial incentives are very popular components of many private-sector programs, the federal government places a number of limitations on the use of such incentives. As an alternative, FedStrive is launching an effort to provide “human incentives.” An HHS customer survey showed that 25 percent of participants said they would be more likely to complete their HRA each year if they were rewarded with an opportunity to have lunch with their director or other HHS leaders. This corresponded with private-sector research showing that strong support or “buy-in” by an organization’s leadership is an important element of a successful workplace health and wellness program. FedStrive is working to establish an incentive program that will allow employees to more closely engage with their leadership. At HHS headquarters in Washington, D.C., FedStrive has already achieved great success in attracting employee participation in health walks with the U.S. Surgeon General.

Evaluation

FedStrive uses various mechanisms in evaluation, including aggregate HRA data and program participation measurement. Leading public health researchers help analyze the data, and results are shared with senior level officials who use the findings to identify program successes and lessons learned, and make programmatic adjustments.

Communication

FedStrive has an online newsletter – “Spotlight” – that features stories from employees who have succeeded in reaching their health goals. It provides an opportunity for employees to hear about FedStrive from their peers, and a chance for FedStrive to recognize individual achievement.

FOH Director, Dr. Gene Migliaccio , tells the story of how proud he was when he overheard an elevator conversation in which an employee was excited about being featured in “Spotlight.” The gentlemen mentioned how he’d been asked to tell his story in the newsletter because he has lost 50 pounds. He said that he’d had a great experience with the program and that the FedStrive nurse had been with him every step of the way, providing encouragement and support.

Lessons Learned

• If an agency does not already have a wellness council with representation across the agency, it is critical to establish one.
• Within the council, focus on developing new, innovative ways to increase program participation, create guidelines that encourage participation, create program champions and recognize health improvements and achievements.
• It is important to communicate program benefits.
• Start employee buy-in before a launch.
• Engage senior leadership and mid-level management to encourage participation.

As HHS Secretary Sebelius said in a discussion of FOH and FedStrive: “The work we do in HHS is important to the Nation’s health. I am equally concerned about your own health. Take care of yourself, so that you can continue to take care of our Nation.”

This interview was conducted with FOH Director, Gene Migliaccio. To find out more about FOH and FedStrive: http://www.foh.hhs.gov/default.asp.

Updates from NIOSH the TOTAL WORKER HEALTH^® Program

NIOSH Convenes Third Annual National Expert Colloquium on TOTAL WORKER HEALTH

The Third Annual National Expert Colloquium on TOTAL WORKER HEALTH was convened by the NIOSH on September 19, 2013 in Washington, D.C. The purpose of the Colloquium was: 1) to create a forum for discussion of current research and practice issues, opportunities and challenges related to an integrated approach to safety, health and well-being; 2) to share individual expert input on current and proposed NIOSH TOTAL WORKER HEALTH Program activities; and, 3) to discuss emerging and priority issues related to health protection and health promotion for the American workforce.

The TWH Program invited 17 experts to engage with NIOSH about current efforts and emerging issues related to the integration of health protection and health promotion in the workplace and beyond. Invited experts represented private industry (IBM; Safeway, Inc; Sodexo, North America;), labor organizations (Farmworker Justice; the Service Employees International Union), academia (American University; Geisel School of Medicine at Dartmouth; Oregon Health & Science University; SUNY-Downstate School of Public Health; University of Colorado School of Public Health and School of Medicine), the public sector (Office of Personnel Management), and other leaders from around the globe (the International Association for Worksite Health Promotion; the Pan-American Health Organization; PRISM; US Healthiest; Viridian Health Management; the Association for Corporate Health Risk Management; Change Agent Work Group).

A summary of the day’s events, authored by Colloquium attendee W. Kent Anger (CROET and Oregon Healthy WorkForce Center, Oregon Health & Science University) is available at http://www.ohsu.edu/blogs/croet/2013/09/20/niosh-holds-national-expert-colloquium-on-twh/.

Updates from NIOSH Centers of Excellence to Promote a Healthier Workforce

The Center for the Promotion of Health in the New England Workplace (CPH-NEW)

The CPH-NEW Healthy Worksite Participatory Program online toolkit for workplace safety and wellness managers will be available in November, 2013. Join the CPH-NEW Mailing List to receive an announcement of webinar training dates: www.uml.edu/cphnew.

“Combining Ergonomics and Wellness Together for Total Worker Health” was the topic of presentations given by CPH-NEW researchers Laura Punnett, ScD and Nicholas Warren, ScD at Massachusetts-based safety and wellness industry meetings in May and September, 2013. Presentation slides can be viewed on the News and Events page of the CPH-NEW website.

The Center for the Promotion of Health in the New England Workplace (CPH-NEW) Pilot Grants Program recently accepted applications from researchers for small grants of up to $10,000 to conduct preliminary studies or demonstration projects. Projects must relate to NIOSH Total Worker Health. Read the RFA and listen to an information webinar on the CPH-NEW Pilot Grants Program website.

Harvard Center for Work, Health and Well-being (CWHW)

The Harvard School of Public Health Center for Work, Health, and Well-being (CWHW) is pleased to announce that one of its main research collaborators, Nico Pronk, Vice President and Chief Science Officer for HealthPartners, has been awarded the prestigious HERO Mark Dundon Research Award from the Health Enhancement Research Organization (HERO). This award recognizes Dr. Pronk’s efforts to enhance and promote research that advances the science of employee health management approaches. It also recognizes his track record of authoring peer-reviewed articles; and serving as principle investigator on, and facilitating research for, studies such as CWHW’s SafeWell study. We are delighted that Dr. Pronk’s many successes are recognized in this award.

University of Iowa Healthier Workforce Center for Excellence (HWCE)

The HWCE Small Business Outreach Project conducted over 15 site visits from July through September to small employers in Iowa and Nebraska. Site visits in Nebraska were organized in collaboration with the Nebraska Safety Council and WorkWell. The purpose of the visits was to learn from employer’s first-hand their experiences in safety, wellness and the integration of health protection and health promotion programs. All employers were award winners and recognized for having exemplary programs. Their experiences, including overcoming challenges, innovative approaches and advice, will be shared with other employers through public presentations, the HWCE monthly Healthier Workforce e-Bulletin, the HWCE website highlighting model programs, social media channels and short vignettes.

Oregon Healthy Workforce Center (ORhwc)

Congratulations to Dr. Leslie Hammer, Co-Director of the Oregon Healthy Workforce Center for receiving the Branford P. Millar Award for Faculty Excellence from the Portland State University. Dr. Hammer’s scholarly contributions to organizational policy, health of employees in our community, and family life of individuals across the globe earned her the Millar award.

The Oregon Healthy Workforce Center was pleased to sponsor five interns this summer. Read our blog post about all CROET’s 12 summer intern projects.

The Oregon Healthy Workforce Center is busy this fall exhibiting and presenting at regional occupational health, safety and wellness conferences on topics related to Total Worker Health. A highlight is Dr. Joe Hurrell’s keynote presentation on “Job Stress: Causes, Consequences and Interventions” for OSH professionals at the Northwest Occupational Health Conference on October 11 in Seaside, Oregon. This presentation was followed by other topics and success stories related to Total Worker Health.

Follow the Oregon Healthy Workforce Center’s news through CROET’s Twitter and Facebook accounts, and our Oregon and the Workplace Blog.

News from our Partners

Despite Furlough, NIOSH Grantees Foster Collaboration for First Time in Denver

On October 3 and 4, representatives from all of the NIOSH extramurally funded centers met for the first time at the University of Denver. The meeting was sponsored by NIOSH’s Office of Extramural Programs. However, NIOSH representatives were unable to attend due to the lapse of FY14 appropriations.

The purposes of this historic meeting included exploring opportunities for future collaboration and research integration across Centers and identifying performance metrics and evaluation strategies for multidisciplinary research and training centers.

Dr. Glorian Sorensen of the Harvard School of Public Health’s Center for Work, Health, & Well-being presented on the topic of Integration of NIOSH Intramural and Extramural Programs, citing collaborative practices from the Total Worker Health Program Centers of Excellence as ways to reduce duplication, improve quality of work, and increase impact of the project.

New Initiatives and Resources

Mental Health Resources for Canadian Employers

Earlier this year, the voluntary National Standard of Canada for Psychological Health and Safety in the Workplace was released. The Standard, championed by the Mental Health Commission of Canada (MHCC), is designed to help employers improve how they protect mental health in the workplace. The MHCC is now launching a three-year case study research study designed to follow the journey of 10-15 Canadian employers as they become industry leaders in workplace mental health. As these organizations work through the staged implementation of the Standard, the MHCC will provide observations and insights at no cost to each organization.

Listed below are some actions employers can start doing today!

• Download the MHCC’s Action Guide for Employers, which provides guidelines that encourage executive leadership to commit to making mental health in their workplace a priority.
• Train employees in Mental Health First Aid so they can recognize emerging mental health problems or crises in themselves and their colleagues, and provide initial help.
• Take advantage of the free and comprehensive set of resources offered by Guarding Minds at Work to help protect and promote psychological health and safety in the workplace.
• Learn about additional solutions for employers and supports for employees offered by Mental Health Works, a national program of the Canadian Mental Health Association.
• Join Partners for Mental Health in taking the pledge to support the improvement of mental health for all Canadians.
• Review a set of executive leadership guidelines that encourage CEOs and other senior leaders to make a decisive commitment to mental health in the workplace.
• Learn more about what the MHCC is doing in its own workplace.

Ohio Bureau of Workers’ Compensation – Workplace Wellness Grant Program

In 2012, Ohio Bureau of Workers’ Compensation (OBWC) launched a Workplace Wellness Grant Program (WGP), which will provide up to $4 million in funds over four years to implement wellness programs at an estimated 266 employers with 13,000 employee participants. After each year of funding, participating employers turn in an annual case study, which includes a survey-based measure of the integration of occupational safety and health programs with wellness programs. The 11 question survey instrument was developed for employers participating in the WGP and has not been validated yet. The first case studies were completed earlier this year. The instrument is available at http://www.ohiobwc.com/downloads/blankpdf/SH-30.pdf (Section II). OBWC and NIOSH are collaborating on a research project to determine the effectiveness and economic return of the WGP and to help to understand the extent and impact of wellness program integration with traditional occupational safety and health programs.

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