The Power of Commitment: Creating an Award-Winning Culture of Health and Well-Being at DTE Energy.

The evidence that a healthy and safe workforce provides a competitive business advantage is increasingly clear. However, how to obtain this may be unclear to many. This article presents a case study showcasing how one large employer worked toward improving its culture of health and well-being. Measuring progress using an established corporate health assessment tool, results improved 75% over a 5-year period. In addition, site scan culture checks showed annual improvement, exceeding best-in-class scores by the fifth year. Building a culture of health and well-being often requires a few years to implement fully and involves a commitment to plan, deploy, improve, and manage over time. Ultimately, by following approaches taken by best-in-class employers, this can be accomplished with some ease and without missteps along the way.

Family Member Experiences in Intensive Care Units Care: Insights From a Family Involvement Tool Implementation Trial.

Family involvement is widely considered an important part of patient care in the intensive care unit. From professional health care organizations, government, and hospital associations, there has been a cultural shift toward family presence as part of a wider commitment to patient-centered care. At the same time, the meaning and impact of family involvement in the intensive care unit setting remain opaque and under-studied. This study employed an ethnographic approach to better understand family involvement in practice and from the perspective of health care professionals and family members by studying an implementation trial of a family involvement tool in two intensive care units over 2 years. The findings revealed that an expanded and self-defined role for family members as carers in the intensive care unit challenged the current configuration of the nurse patient/family relationship and that family members were aware of these dynamics. While the intensive care unit implementation teams were both motivated to implement a novel way of facilitating family involvement, the processual, organizational, and contextual factors in the intensive care units largely determined the possibilities of its application. This suggests that interventions should address the specific context in which they are employed.

The Untapped Potential of the Quadruple Aim of Primary Care to Foster a Culture of Health.

In 2015, the Robert Wood Johnson Foundation introduced the Culture of Health (CoH) action model to inform its grantmaking decisions in the United States. The essential principles of this model fall into four action dimensions: 1) making health a shared value, 2) fostering cross-sector collaboration, 3) creating more equitable communities, and 4) transforming healthcare systems. Although considerable success has been achieved since introduction of the CoH model, the pace of progress has been slower on the fourth dimension, since work in this area involves shifting mindsets from the acute care paradigm to one that focuses on prevention, by addressing the "upstream factors", including social and behavioral determinants impacting health. Moreover, despite its academic prominence, the CoH model remains restricted to the research realm, with limited translation to practice. By comparison, the Quadruple Aim (QA) is a four-dimensional framework that has been successfully translated into primary healthcare practice. Introduced in 2008, the QA entails the adoption of four principles in delivering healthcare: 1) improved patient experience, 2) population health, 3) lower costs, and 4) care team well-being, to achieve value in healthcare. The four principles of the QA could be viewed as analogous to the four principles of the CoH, given the inherent synergies in the underlying philosophy of the two frameworks. It is also noteworthy that both healthcare leadership (physician champions) and legislative reform had significant roles to play in the successful translation of the QA into mainstream practice. This in turn suggests that the primary healthcare system has potential to play an instrumental role in accelerating the pace of progress towards a culture of health by extending the scope of influence of the QA. This paper explores the inherent synergies between the QA and CoH models, and the untapped potential of the QA to foster a culture of health in the United States.

A Scoping Review of Workplace Culture of Health Measures.

OBJECTIVE: This study aimed to review existing measures of workplace culture of health and to examine the health and wellbeing outcomes associated with workplace culture of health. DATA SOURCES: PubMed/Medline, Web of Science, and PsycINFO databases searched through February 2022. STUDY INCLUSION AND EXCLUSION CRITERIA: Articles were included if they used a specific measure to assess culture of health in the workplace and were published in English. Articles were excluded if there was no quantitative measure of health culture. DATA EXTRACTION: Data from each article was extracted using a structured template which included study purpose, participants and setting, study design, intervention strategies (if applicable), culture of health measure, and results. DATA SYNTHESIS: We described culture of health measures used and summarized key findings from included articles. RESULTS: The search yielded 31 articles measuring workplace culture of health (three validation, two intervention, and 26 observational studies). Nineteen unique measures were used across all articles. Most studies examined culture of health from the employee perspective (n = 23), while others examined it at the organizational level (n = 7). The studies indicated a positive relationship between health and well-being outcomes and a strong workplace health culture. CONCLUSION: There are many different approaches to measuring workplace health culture. Overall, workplace culture of health is related to positive employee and organizational health and wellbeing outcomes.

Association of Workplace Culture of Health and Employee Emotional Wellbeing.

The study aimed to examine associations between workplace culture of health and employee work engagement, stress, and depression. Employees (n = 6235) across 16 companies voluntarily completed the Workplace Culture of Health (COH) Scale and provided data including stress, depression, and biometrics through health risk assessments and screening. We used linear regression analysis with COH scores as the independent variable to predict work engagement, stress, and depression. We included age, gender, job class, organization, and biometrics as covariates in the models. The models showed that total COH scores were a significant predictor of employee work engagement (b = 0.75, p < 0.001), stress (b = -0.08, p < 0.001), and depression (b = 0.08, p < 0.001). Job class was also a significant predictor of work engagement (b = 2.18, p < 0.001), stress (b = 0.95, p < 0.001), and depression (b = 1.03, p = 0.02). Gender was a predictor of stress (b = -0.32, p < 0.001). Overall, findings indicate a strong workplace culture of health is associated with higher work engagement and lower employee stress and depression independent of individual health status. Measuring cultural wellbeing supportiveness can help inform implementation plans for companies to improve the emotional wellbeing of their employees.

A Culture of Health and Alcohol-Permitted Events at a U.S. University.

We examined event organizers' understandings and management of alcohol-related risk and accommodation of people in recovery from substance use disorders and other non-drinkers, when organizing alcohol-permitted events that primarily involved faculty, staff, and graduate students. We interviewed 31 event organizers at a large, public university in California. Organizers were most concerned about avoiding legal liabilities, were less concerned about promoting responsible drinking among drinkers, and often failed to consider the needs of non-drinkers. Their actions were informed by problematic beliefs about alcohol (e.g., people need alcohol to relax and socialize), drinkers (e.g., only undergraduate students engage in risky alcohol consumption), and people in recovery (e.g., they lack self-control). Organizers over-relied on informal control to shape attendees' behavior, failing to acknowledge contextual factors. They need education on how they can shape the event context to better promote healthy behaviors, avoid exclusively focusing on informal control and prevention of unhealthy behaviors, and promote better inclusion of people who do not drink alcohol. There is fertile ground for infusing a culture of health into events in higher education.

Associations of recognition at work with subsequent health and quality of life among older working adults.

PURPOSE: Recognition for work-an act of conveying non-financial appreciation for an outstanding accomplishment or performance-is the top motivator of employee performance and important contributor to psychologically healthy work. Employee recognition programs are offered by many companies and have been shown to retain top talent, increase job satisfaction, and performance. Yet, evidence on the role of received employee recognition for health and quality of life remains limited. This study examined whether receiving recognition for work was prospectively associated with six indicators of health, quality of life, and loneliness. METHODS: Data were retrieved from the Survey of Health, Ageing and Retirement in Europe (SHARE), a biennial cross-national panel database of people aged > 50 years. Our sample included 5,048 middle-aged and older working adults. RESULTS: The results indicated that employees receiving recognition for work reported higher quality of life ([Formula: see text]=0.065, 95% CI = 0.047, 0.082), had lower risks of hypertension (RR = 0.932; 95% CI = 0.899, 0.966) and high blood cholesterol (RR = 0.922; 95% CI = 0.879, 0.967). These associations were independent of demographics, socioeconomic status, personality, prior history of diseases, depression, lifestyle, and work conditions. The set of sensitivity analyses provided substantial evidence for the robustness of the associations between recognition for work and quality of life as well as hypertension but not necessarily with high blood cholesterol. CONCLUSIONS: Promotion of employee recognition might emerge as a valuable business resource and health policy tool helping middle-aged and older adults maintain health and good quality of life. It may also help willing older adults to remain on the labour market until older age.

Supporting Employee Health at Work: How Perceptions Differ Across Wage Category.

PURPOSE: This study examines the association between sources of stress and perceptions of organizational and supervisor support for health and well-being. DESIGN: Retrospective, cross-sectional analysis. SETTING: Large university in the mid-western United States. SAMPLE: This study focused on university employees with complete data for all variables (organizational support/N = 19,536; supervisor support/N = 20,287). MEASURES: 2019 socioeconomic and demographic characteristics, count of chronic conditions, sources of stress and perceptions of organizational and supervisor support. ANALYSIS: For the multivariate analyzes, linear regression models were analyzed separately by wage bands (low ≤$46,100; middle >$46,100-$62,800; high >$62,800). RESULTS: For all employees, workplace stressors, including problematic relationships at work and heavy job responsibilities, were negatively associated with perceptions of supervisor and organizational support. In comparison, the most salient home-based stressors were negatively associated with perceptions of supervisor support for the lowest-wage band (the death of a loved one, b = -0.13) and middle-wage band (personal illness or injury, b = -0.09), while the one for the highest-wage band (illness or injury of a loved one, b = 0.07) was positively associated with perceptions of supervisor support. CONCLUSION: Stressful job responsibilities and work relationships are associated with lower perceptions of supervisor and organizational support for health and well-being across all wage bands. Favorable perceived support for personal stressors only among high wage earning employees may suggest a need for improved equity of perceived support for these stressors among lower wage workers.

Problematizing "Planning Ahead": A Cross-Cultural Analysis of Vietnamese Health and Community Workers' Perspectives on Advance Care Directives.

Informed by values of autonomy and self-determination, advance care planning assumes that individuals should independently take control of their future health. In this article, we draw on research conducted with Vietnamese health and community workers to problematize individualized approaches to planning ahead, reframe notions of "cultural and linguistic barriers," and expose how homogeneous messages about care at the end of life are not readily translatable within and across diverse groups. Anthropological and feminist critiques of inclusion and exclusion are used to reorientate Anglophone framings of the individual and of cultural and linguistic differences. In this article, we suggest that it is the narrow singularity of care for the self-rather than diverse relationalities of care-that should be overcome if aging and end-of-life care policy and practice is to be broadened and made relevant to migrant and non-English-speaking groups.

Perspectives on Racism: Reflections on Our Collective Moral Responsibility When Leveraging Arts and Culture for Health Promotion.

In this commentary essay, I examine the collective moral responsibility of leveraging arts and culture for health promotion, and the role ethical storytelling can play in reframing how health educators promote "good health" with specific regard to the next generation of the workforce. I reflect on the impact of racism, White supremacy, and anti-Blackness when merging the arts and culture sector with public health disciplines, and close with a call to action as our niche field expands. I argue that no matter our role as artists, cultural workers, heritage holders, and/or focus within public health education and health promotion, our work is both an art and a science. Just as the language we use forms a story, the collection of scholars we choose to cite exposes a narrative. I hope this commentary encourages readers to reflect on opportunities in their work to close the health equity gap with recognition of the knowledge, skills, abilities, and capital within and across Black culture while also lifting up the community cultural wealth that exists in Indigenous, Latinx, and Asian and Pacific Islander communities.

Urban mobile food truck policies: reducing disparities and building a culture of health in the United States.

We undertook this study knowing that for people throughout the Midwest who live in low-income urban neighborhoods, finding and affording healthy foods continues to be a problem. People with less money are not only forced to spend it on food, but have so limited options for avoiding purchase of foods with high levels of fat, salt, and sugar. A review of the literature shows that very little is known about how mobile food trucks can increase availability and affordability of healthy foods in low-income neighborhoods in the United States. We compared municipal codes regulating mobile food truck operators and evaluated the impact on cities in the Midwest for encouraging a 'culture of health.' We analyzed six Midwest metropolitan areas with the highest proportion of minorities who lived below the poverty level and had mobile food trucks selling provisions in their neighborhoods. We found that developing more incentives for mobile food truck operators to sell healthier food options can contribute to improving health outcomes in low-income neighborhoods.

The Critical Role of Racial/Ethnic Data Disaggregation for Health Equity.

Population-level health outcomes and measures of well-being are often described relative to broad racial/ethnic categories such as White or Caucasian; Black or African American; Latino or Hispanic; Asian American; Native Hawaiian and Pacific Islander; or American Indian and Alaska Native. However, the aggregation of data into these groups masks critical within-group differences and disparities, limiting the health and social services fields' abilities to target their resources where most needed. While researchers and policymakers have recognized the importance of disaggregating racial/ethnic data-and many organizations have advocated for it over the years-progress has been slow and disparate. The ongoing lack of racial/ethnic data disaggregation perpetuates existing inequities in access to much-needed resources that can ensure health and well-being. In its efforts to help build a Culture of Health and promote health equity, the Robert Wood Johnson Foundation has supported activities aimed to advance the meaningful disaggregation of racial/ethnic data-at the collection, analysis, and reporting phases. This special issue presents further evidence for the importance of disaggregation, the technical and policy challenges to creating change in practice, and the implications of improving the use of race and ethnicity data to identify and address gaps in health.

Examining the Impact of Wellness Champions on the Effectiveness of a Workplace Health and Well-Being Program.

PURPOSE: To evaluate the impact of Desire2Move (D2M) implementation fidelity by Wellness Champions on program effectiveness. DESIGN: Cross-sectional. SETTING: Years 1, 3, and 5 of D2M; an annual peer support health and well-being initiative for university employees. PARTICIPANTS: D2M participants included 422 employees from 28 teams; however, only 144 provided survey data (34.1% response rate). INTERVENTION: During the 8-week program, departments competed as teams to accumulate the greatest average physical activity (PA) minutes. Each team selected a Wellness Champion who delivered program information. Each team member recorded PA minutes with MapMyFitness. MEASURES: An electronic survey assessed program implementation fidelity and program satisfaction. ANALYSIS: Median split (median [Mdn] = 21.2) categorized teams into "high" (n = 14; Mdn = 24.0, range = 21.4-25.0) and "low" (n = 14; Mdn = 19.4, range = 14.3-21.0) implementation groups. Independent samples t tests evaluated differences between groups on program satisfaction and team program average PA minutes. RESULTS: Groups were significantly different for program satisfaction, t(26) = -2.76, P = .011, and team program average PA minutes, t(26) = -2.40, P = .024. The "high" implementation group reported greater program satisfaction (mean [M] = 12.6, standard deviation [SD] = 1.8) and team program average PA minutes (M = 2104.4, SD = 807.4) than the "low" implementation group (program satisfaction M = 11.1, SD = 1.1; team program average minutes M = 1340.8, SD = 875.8). CONCLUSION: Wellness Champions positively impacted employee PA participation and program satisfaction.

Nurse-Led Intervention Promoting Healthy Lifestyle Behaviors in a Yazidi Community.

Introduction: Immigrating to a new country poses many challenges, including managing daily health care in a new environment. Yazidis experiencing long-standing ethnoreligious persecution in Northern Iraq, fled their homeland seeking safety and refuge in the United States, where approximately 10,000 Yazidi immigrants reside. Method: The researchers collaborated with Yazidi community members to design the healthy lifestyle intervention and ensure cultural sensitivity. Six weekly classes addressed healthy lifestyle behaviors. Data were collected on health promoting activities, biomarkers, and participants' experiences with the intervention. Results: Participants reported doing slightly more health promoting activities postintervention. Age-related health promoting activities were significantly different at baseline, χ2(2) = 6.093, p = .048, but not postintervention, χ2(2) = 0.212, p = .899. Median loss in biomarkers trended toward clinically significant findings. Participants recommended more strategies to manage stress. Discussion: The pilot study provided an empowering example of nurses collaborating with community members to design a culturally sensitive intervention.

Looking backwards to move forward: Using a social mission lens in nursing education.

The ideals of health equity continue to be constrained by the conditions in which people live, learn and work. But to what extents are nursing schools strengthening the preparedness of nurses to extend their reach and help individuals and communities achieve their highest level of health? A culture of health and health equity is built on a framework of social mission. The authors believe that social mission is not new to the nursing profession. However, a clear understanding of the historical evolution of social mission as it relates to nursing education could provide a solid foundation for understanding the extent to which nursing curricula aligns with a commitment to advancing healthcare outcomes. This manuscript is a commentary that outlines the foundational understanding of the history of social mission in nursing education through the present time and amplifies that educators should consider how adopting a social mission lens could help schools more effectively align their curricula, policies and practices with health equity. Social mission refers to the school's commitment to advance health equity in everything it does from admissions and faculty hiring policies, to curriculum development, the extent of community based experiential learning, and, ultimately measured in their graduates' outcomes (Mullan, 2017). It is the authors' view that the rich history, the magnitude of the sector, and the current transformational conversations occurring in the nursing profession, all call for a deeper analysis and engagement of nursing leaders in this topic.

Among Low-Income Women In San Francisco, Low Awareness Of Paid Parental Leave Benefits Inhibits Take-Up.

Paid family leave policies have the potential to reduce health disparities, yet access to paid leave remains limited and unevenly distributed in the United States. Using California administrative claims data, we examined the impact of the San Francisco Paid Parental Leave Ordinance, the first in the US to provide parental leave with full pay. We found that the law increased parental leave uptake in San Francisco by 13 percent among fathers, but there was little change in leave among mothers. Data from a survey of mothers suggest that the limited impact may be partly a result of low understanding of benefits. Lower-income mothers reported even less knowledge of their maternity leave benefits than other mothers, and fewer than 2 percent of lower-income mothers had accurate information about the policy. The San Francisco policy also excludes small employers, which further limits its reach among low-income workers. A simpler universal policy may be more effective in expanding parental leave among vulnerable workers.

NurseTRUST: A Leadership Model for Advancing Population Health.

An interview with one of the current leaders for NurseTRUST tells the story of a newly formed organization to advance nursing leadership to address population health. The vision has always been to prepare nurse leaders for advanced positions in senior leadership roles in healthcare. The RWJ-Nurse Executive Fellowship created national leaders to influence population health. The postprogram Fellows are leveraging this design for the next generation of leaders through the NurseTRUST organization. The network of trusted colleagues can address emerging issues with their national colleagues who are leaders in their field while mentoring the next generation of nurse leaders.