Process evaluation of two participatory approaches: Implementing total worker health® interventions in a correctional workforce.

BACKGROUND: Correctional Officers (COs) have among the highest injury rates and poorest health of all the public safety occupations. The HITEC-2 (Health Improvement Through Employee Control-2) study uses Participatory Action Research (PAR) to design and implement interventions to improve health and safety of COs. METHOD: HITEC-2 compared two different types of participatory program, a CO-only "Design Team" (DT) and "Kaizen Event Teams" (KET) of COs and supervisors, to determine differences in implementation process and outcomes. The Program Evaluation Rating Sheet (PERS) was developed to document and evaluate program implementation. RESULTS: Both programs yielded successful and unsuccessful interventions, dependent upon team-, facility-, organizational, state-, facilitator-, and intervention-level factors. CONCLUSIONS: PAR in corrections, and possibly other sectors, depends upon factors including participation, leadership, continuity and timing, resilience, and financial circumstances. The new PERS instrument may be useful in other sectors to assist in assessing intervention success. Am. J. Ind. Med. 59:897-918, 2016. © 2016 Wiley Periodicals, Inc.

Considering the Differential Impact of Three Facets of Organizational Health Climate on Employees' Well-Being.

One potential way that healthy organizations can impact employee health is by promoting a climate for health within the organization. Using a definition of health climate that includes support for health from multiple levels within the organization, this study examines whether all three facets of health climate--the workgroup, supervisor, and organization--work together to contribute to employee well-being. Two samples are used in this study to examine health climate at the individual level and group level in order to provide a clearer picture of the impact of the three health climate facets. k-means cluster analysis was used on each sample to determine groups of individuals based on their levels of the three health climate facets. A discriminant function analysis was then run on each sample to determine if clusters differed on a function of employee well-being variables. Results provide evidence that having strength in all three of the facets is the most beneficial in terms of employee well-being at work. Findings from this study suggest that organizations must consider how health is treated within workgroups, how supervisors support employee health, and what the organization does to support employee health when promoting employee health.

Assessment of organizational readiness for participatory occupational safety, health and well-being programs.

BACKGROUND: Organizational readiness for change measures were reviewed to develop an assessment tool for guiding implementation of an occupational safety and health program based on Total Worker Health (TWH) principles. Considerable conceptual ambiguity in the theoretical and empirical peer-reviewed literature was revealed. OBJECTIVE: Develop and validate an assessment tool that organizations can use to prepare for implementation of a participatory TWH program. METHODS: Inclusion criteria identified 29 relevant publications. Analysis revealed eight key organizational characteristics and predictors of successful organizational change. A conceptual framework was created that subject matter experts used to generate prospective survey items. Items were revised after pretesting with 10 cognitive interviews with upper-level management and pilot-tested in five healthcare organizations. Reliability of the domain subscales were tested based on Cronbach's α. RESULTS: The Organizational Readiness Tool (ORT) showed adequate psychometric properties and specificity in these eight domains: 1) Current safety/health/well-being programs; 2) Current organizational approaches to safety/health/well-being; 3) Resources available for safety/health/well-being; 4) Resources and readiness for change initiatives to improve safety/health/well-being; 5) Resources and readiness for use of teams in programmatic initiatives; 6) Teamwork; 7) Resources and readiness for employee participation; and 8) Management communication about safety/health/well-being. Acceptable ranges of internal consistency statistics for the domain subscales were observed. CONCLUSIONS: A conceptual model of organizational readiness for change guided development of the Organizational Readiness Tool (ORT), a survey instrument designed to provide actionable guidance for implementing a participatory TWH program. Initial internal consistency was demonstrated following administration at multiple organizations prior to implementation of a participatory Total Worker Health® program.

Impact of a Total Worker Health® Mentoring Program in a Correctional Workforce.

(1) Background: Correctional Officers show signs of adverse health early in their careers. We evaluated the impact of a one-year peer health mentoring program for new officers based on a Total Worker Health® approach; (2) Methods: Cadets (n = 269) were randomly assigned to a mentored or control group. Cadets in this mixed methods design completed physical assessments, and surveys at three time points to assess demographics, health, mentoring, and workplace variables. Physical testing included several health markers. Surveys and physical data were analyzed as repeated measures. Regression analyses were used to analyze the relationship between mentoring characteristics and outcomes. A semi-structured interview of mentors was analyzed qualitatively. (3) Results: Higher mentoring frequency was associated with lower burnout. Health behaviors and outcomes declined over time in all groups, but mentees displayed slower decline for body mass index (BMI) and hypertension compared to controls. (4) Conclusions: A continuous peer health mentoring program seemed protective to new officers in reducing burnout and also declines in BMI and hypertension. Short-term physical health markers in younger officers may not be an index of psycho-social effects. A participatory design approach is recommended for a long-term health mentoring program to be both effective and sustainable.

A mixed-method approach to tailor the implementation of a participatory Total Worker Health® program.

Purpose ­: Total Worker Health® (TWH) programs, which represent a holistic approach for advancing worker safety, health and well-being, require an employer to adapt programmatic coordination and employee involvement in program design and delivery. Organizational readiness for such measures requires competencies in leadership, communication, subject expertise and worker participation. In the absence of documented methods for TWH readiness assessment, the authors developed a process to prospectively identify implementation facilitators and barriers that may be used to strengthen organizational competencies and optimize the organizational "fit" in advance. Design/methodology/approach ­: The mixed-method baseline assessment instruments comprised an online organizational readiness survey and a key leader interview; these were administered with key organizational and labor leaders in five US healthcare facilities. Findings about organizational resources, skills available and potential implementation barriers were summarized in a stakeholder feedback report and used to strengthen readiness and tailor implementation to the organizational context. Findings ­: The research team was able to leverage organizational strengths such as leaders' commitment and willingness to address nontraditional safety topics to establish new worker-led design teams. Information about program barriers (staff time and communication) enabled the research team to respond with proactive tailoring strategies such as training on participant roles, extending team recruitment time and providing program communication tools and coaching. Originality/value ­: A new method has been developed for prospective organizational readiness assessment to implement a participatory TWH program. The authors illustrate its ability to identify relevant organizational features to guide institutional preparation and tailor program implementation.

Evaluation of the HearWell Pilot Program: A Participatory Total Worker Health® Approach to Hearing Conservation.

Our objective was to pilot test HearWell, an intervention created to preserve hearing among highway maintainers, by using a participatory Total Worker Health® (TWH) approach to designing, implementing and evaluating interventions. Regional maintenance garages were randomized to control (n = 6); HearWell (n = 4) or HearWell Design Team (n = 2) arms. Maintainer representatives from the HearWell Design Team garages identified barriers to hearing health and collaborated to design interventions including a safety leadership training for managers, a noise hazard management scheme to identify noise levels and indicate the hearing protection device (HPD) needed, and a comprehensive HearWell training video and protocol. These worker-designed interventions, after manager input, were delivered to the HearWell Design Team and the HearWell garages. Control garages received standard industry hearing conservation training. Periodic surveys of workers in all 12 garages collected information on the frequency of HPD use and a new hearing climate measure to evaluate changes in behaviors and attitudes over the study period and following interventions. An intention-to-treat approach was utilized; differences and trends in group HPD use and hearing climate were analyzed using a mixed-effects model to account for repeated measures from individual participants. The HearWell Design Team maintainers reported the highest frequency of HPD use. Hearing climate improved in each group 6 months following intervention implementation, with the largest increase and highest value for the HearWell Design Team workers. The HearWell pilot intervention showed promising results in improving HPD use through a participatory TWH approach to hearing conservation. Furthermore, results suggest that employee participation in hearing conservation programs may be necessary for maximal effectiveness.

Development and Implementation of a Total Worker Health® Mentoring Program in a Correctional Workforce.

Correctional officers (COs) are exposed to a number of occupational stressors, and their health declines early in their job tenure. Interventions designed to prevent early decline in CO health are limited. This article describes the development, implementation, and evaluation of a one-year peer health mentoring program (HMP) guided by Total Worker Health® principles and using a participatory action research to collectively address worker safety, health, and well-being of newly hired COs. The HMP aimed to provide new COs with emotional and tangible forms of support during their first year of employment, including peer coaching to prevent early decline in physical fitness and health. The development and implementation of the HMP occurred across five main steps: (1) participatory design focus groups with key stakeholders; (2) adaptation of an existing mentoring handbook and training methods; (3) development of mentor-mentee recruitment criteria and assignment; (4) designing assessment tools; and (5) the initiation of a mentor oversight committee consisting of union leadership, corrections management, and research staff. Correctional employee engagement in the design and implementation process proved to be efficacious in the implementation and adaptation of the program by staff. Support for the HMP remained high as program evaluation efforts continued.

Defining 'Integration' for Total Worker Health®: A New Proposal.

The effects of work and the conditions of employment on health behaviors and intermediate health conditions have been demonstrated, to the extent that these relationships should be addressed in efforts to prevent chronic disease. However, conventional health promotion practice generally focuses on personal risk factors and individual behavior change. In an effort to find solutions to the myriad of health challenges faced by the American workforce, the U.S. National Institute for Occupational Safety and Health (NIOSH) established the Total Worker Health® (TWH) program. Originally organized around the paradigm of integrating traditional occupational safety and health protections with workplace health promotion, TWH has evolved to a broader emphasis on workplace programs for enhancing worker safety, health, and well-being. Among the research programs and approaches developed by investigators at NIOSH Centers of Excellence for TWH and elsewhere, definitions of 'integration' in workplace interventions vary widely. There is no consensus about which organizational or individual outcomes are the most salient, how much to emphasize organizational contexts of work, or which program elements are necessary in order to qualify as 'Total Worker Health'. Agreement about the dimensions of integration would facilitate comparison of programs and interventions which are self-defined as TWH, although diverse in content. The specific criteria needed to define integration should be unique to that concept-i.e. distinct from and additive to conventional criteria for predicting or evaluating the success of a workplace health program. We propose a set of four TWH-specific metrics for integrated interventions that address both program content and process: (i) coordination and interaction of workplace programs across domains; (ii) assessment of both work and non-work exposures; (iii) emphasis on interventions to make the workplace more health-promoting; and (iv) participatory engagement of workers in pivotal ways during intervention prioritization and planning to develop self-efficacy in addressing root causes, skill transfer, building program ownership, empowerment, and continuous improvement. Thus we find that integration requires organizational change, both to engage two managerial functions with different goals, legal responsibilities, and (often) internal incentives & resources, and also to orient the organization toward salutogenesis. Examples from research activity within the Center for the Promotion of Health in the New England Workplace illustrate how these criteria have been applied in practice.

The Nature of the Firm - A social cybernetic analysis.

BACKGROUND: In 1937, Ronald Coase published 'The Nature of the Firm' [1], addressing the question of why firms exist. He concluded that firms emerge to reduce costs of transactions. A 'transaction' is defined both as the action of conducting business, as well as an interaction between people. OBJECTIVE: Both senses of the term prompt the present social cybernetic analysis of the nature of the firm. Social cybernetics focuses upon the reciprocal feedback control and feedforward interactions between two or more individuals in a group or organizational setting, a process termed social tracking. METHODS: Social cybernetic principles can be used to understand how firms establish and maintain the high levels of transactional efficiency necessary to survive and remain competitive. RESULTS: Selected examples are introduced, and subjected to social cybernetic analysis, of the types of transactions that the manager of a firm is expected to engage in regularly and with a high degree of effectiveness. CONCLUSIONS: From the perspective of social cybernetics, the potential for continued market success of a firm is equated with the degree to which the fidelity of social tracking among transactional participants is developed, maintained and refined through organizational design and management.

A practical scale for Multi-Faceted Organizational Health Climate Assessment.

The current study sought to develop a practical scale to measure 3 facets of workplace health climate from the employee perspective as an important component of a healthy organization. The goal was to create a short, usable yet comprehensive scale that organizations and occupational health professionals could use to determine if workplace health interventions were needed. The proposed Multi-faceted Organizational Health Climate Assessment (MOHCA) scale assesses facets that correspond to 3 organizational levels: (a) workgroup, (b) supervisor, and (c) organization. Ten items were developed and tested on 2 distinct samples, 1 cross-organization and 1 within-organization. Exploratory and confirmatory factor analyses yielded a 9-item, hierarchical 3-factor structure. Tests confirmed MOHCA has convergent validity with related constructs, such as perceived organizational support and supervisor support, as well as discriminant validity with safety climate. Lastly, criterion-related validity was found between MOHCA and health-related outcomes. The multi-faceted nature of MOHCA provides a scale that has face validity and can be easily translated into practice, offering a means for diagnosing the shortcomings of an organization or workgroup's health climate to better plan health and well-being interventions.

Participatory design of integrated safety and health interventions in the workplace: a case study using the Intervention Design and Analysis Scorecard (IDEAS) Tool.

Total Worker Health™ (TWH) interventions for improved employee safety, health and wellbeing depend on integrated approaches that involve changes to the workplace or work organisation as well as behavioural or lifestyle changes made by workers. Intervention Design and Analysis Scorecard (IDEAS) Tool to engage front-line employees in planning TWH interventions and obtaining needed management support. The IDEAS Tool consists of seven planning steps in a scorecard approach that helps front-line employees systematically examine root causes of health/safety problems/issues and develop intervention alternatives. A comprehensive business case is then developed for each proposed intervention through analysis of costs/benefits, resources and barriers, and scope of impact. A case study is presented in which maintenance technicians at a property management firm used the IDEAS Tool to plan and successfully implement multiple interventions to reduce work overload. A participatory systems taxonomy is used to help explain why such a structured approach to intervention planning is needed to create a sustainable program for the continuous improvement of employee safety, health and wellbeing for TWH.

Participatory ergonomics: development of an employee assessment questionnaire.

Despite being essential to the success of participatory ergonomics (PEs) programs, there are currently no known quantitative measures that capture the employees' perspective of PE program effectiveness. The present study addresses this need through the development of the Employee Perceptions of Participatory Ergonomics Questionnaire (EPPEQ). The questionnaire is designed to assess five key components that are based on a review of the available literature: Employee Involvement, Knowledge Base, Managerial Support, Employee Support, and Strain related to ergonomic changes. In Phase 1, a sample of employees and ergonomists working at a manufacturing plant was used to develop and test an initial set of items. In Phase 2, data was collected from a nation-wide sample of employees representing a wide range of jobs and organizations to cross-validate the results from Phase 1. Phase 2 results indicate that the five EPPEQ subscales demonstrate sound convergent validity and are also correlated with traditional indicators of PE program success. Implications and uses of the EPPEQ are discussed.