Small Business Total Worker Health: a Conceptual and Methodological Approach to Facilitating Organizational Change
- 1k Downloads
Nearly half of Americans are employed by small businesses, and future projections suggest that the number of those employed by small businesses will rise. Despite this, there is relatively little small business intervention research on the integration of health protection and health promotion, known as Total Worker Health® (TWH). We first discuss the importance of studying small businesses in TWH research and practice. Second, we describe an example of a small business TWH intervention, Health Links™ plus TWH owner/senior manager leadership training, that we are evaluating via the Small+Safe+Well (SSWell) study. Key features of the intervention and the SSWell study include attention to multi-level influences on worker health, safety and well-being; organizational change; and dissemination and implementation science strategies via the RE-AIM model. We offer several considerations for future small business TWH research and practice both in terms of the small business context as well as intervention development and evaluation. Our goal is to provide TWH researchers and practitioners with a framework and an example of how to approach small business TWH interventions. Ultimately, through the SSWell study, we aim to provide small businesses with strong evidence to support the use of TWH strategies that are practical, effective and sustainable.
KeywordsOccupational health intervention Organizational climate Health promotion Worker safety Occupational health and safety Dissemination and implementation science
This publication was supported by the Cooperative Agreement number, 1 U19 OH 011227, funded by the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
Compliance with Ethical Standards
Conflict of Interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- Basen-Engquist, K., Hudmon, K.S., Tripp, M., & Chamberlain, R., (1998). Worksite health and safety climate: Scale development and effects of a health promotion intervention. Preventative Medicine, 27, 111–119. https://doi.org/10.1006/pmed.1997.0253.
- Bonney, T., Forst, L., Rivers, S., Love, M., Pratap, P., Bell, T., & Fulkerson, S. (2017). Occupational safety and health in the temporary services industry: A model for a community-university partnership. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 27(2), 246–259. https://doi.org/10.1177/1048291117712545.CrossRefGoogle Scholar
- Bradley, C. J., Grossman, D. C., Hubbard, R. A., Ortega, A. N., & Curry, S. J. (2016). Integrated interventions for improving Total worker health: A panel report from the National Institutes of Health pathways to prevention workshop: Total worker health—What’s work got to do with it? Annals of Internal Medicine, 1–7. https://doi.org/10.7326/M16-0740.
- Bureau of Labor Statistics. (2015). TABLE Q1. Incidence rates of total recordable cases of nonfatal occupational injuries and illnesses by quartile distribution and employment size, 2015. Retrieved from https://www.bls.gov/iif/oshwc/osh/os/ostb4748.pdf.
- Burke, M. J., & Signal, S. M. (2010). Workplace safety: A multilevel, interdisciplinary perspective. In H. Liao, J. Martocchio, & A. Joshi (Eds.), Research in personnel and human resources management (Vol. 29, pp. 1–47). Emerald Group Publishing Limited.Google Scholar
- Burton, J. (2010). WHO healthy workplace framework and model: Background and supporting literature and practices. Retrieved from http://www.who.int/occupational_health/healthy_workplaces/en/
- Centers for Disease Control. (2015). Worksite health scorecard. Retrieved from http://www.cdc.gov/dhdsp/pubs/worksite_scorecard.htm
- Choi, E. J., & Spletzer, J. R. (2012). The declining average size of establishments: Evidence and explinations. Monthly Labor Review, 135, 50–65.Google Scholar
- Colorado Governor's Council for Active and Healthy Lifestyles. (2017). Colorado Governor's Council Awards. Retrieved from http://www.coloradofitness.org/awards.
- Crimmel, B. L. (2013). Changes in self-insured coverage for employer-sponsored health insurance: Private sector, by firm size, 2001–2011. Retrieved from https://meps.ahrq.gov/data_files/publications/st412/stat412.pdf.
- Dong, X. S., Fujimoto, A., Ringen, K., Stafford, E., Platner, J. W., Gittleman, J. L., & Wang, X. (2011). Injury underreporting among small establishments in the construction industry. American Journal of Industrial Medicine, 54(5), 339–349. https://doi.org/10.1002/ajim.20928.CrossRefPubMedGoogle Scholar
- Feltner, C., Peterson, K., Weber, R. P., Cluff, L., Coker-Schwimmer, E., Viswanathan, M., & Lohr, K. N. (2016). The effectiveness of total worker health interventions: A systematic review for a National Institutes of Health pathways to prevention workshop. Annals of Internal Medicine, 165(4), 262–269. https://doi.org/10.7326/M16-0626.CrossRefPubMedGoogle Scholar
- Forst, L., Ahonen, E., Zanoni, J., Holloway-Beth, A., Oschner, M., Kimmel, L., et al. (2013). More than training: Community-based participatory research to reduce injuries among Hispanic construction workers. American Journal of Industrial Medicine, 56(8), 827–837. https://doi.org/10.1002/ajim.22187.CrossRefPubMedGoogle Scholar
- Glasgow, R., & Emmons, K. (2007). How can we increase translation of research into practice? Types of evidence needed. Annual Review of Public Health, 28(1), 413–433. https://doi.org/10.1146/annurev.publhealth.28.021406.144145.CrossRefPubMedGoogle Scholar
- Harris, J. R., Hannon, P. A., Beresford, S. A. A., Linnan, L. A., & McLellan, D. L. (2014). Health promotion in smaller workplaces in the United States. Annual Review Public Health, 35(1), 327–342. https://doi.org/10.1146/annurev-publhealth-032013-182416.CrossRefGoogle Scholar
- Health Links. (2017). Health Links. Retrieved from https://www.healthlinkscertified.org/.
- Healthier Workforce Center of the Midwest. (2017). Small business outreach project. Retrieved from https://www.public-health.uiowa.edu/hwcmw/outreach/small-business-outreach/.
- Howard, J. (2017). NIOSH Science Blog: Nonstandard work arrangements. Retrieved from https://blogs.cdc.gov/niosh-science-blog/2017/01/03/nonstandard-work-arrangements/.
- Institute of Medicine. (2014). Promising and best practices in total worker health: workshop summary. Washington, DC: The National Academies Press.Google Scholar
- Johnson, S. K., Garrison, L. L., Hernez-Broome, G., Fleenor, J. W., & Steed, J. L. (2012). Go for the goal(s): Relationship between goal setting and transfer of training following leadership development. Academy of management learning and education, 11(4), 555–569. https://doi.org/10.5465/amls.2010.0149.CrossRefGoogle Scholar
- Kouzes, J. M., & Posner, B. Z. (2012). The leadership challenge: How to make extraordinary things happen in organizations (5th ed.). San Francisco: Wiley.Google Scholar
- Laborers Health and Safety Fund of North America. (2017). Laborders Health and Safety Fund of North America. Retrieved from https://www.lhsfna.org/
- McCoy, K., Stinson, K., Scott, K., Tenney, L., & Newman, L. S. (2014). Health promotion in small business: A systematic review of factors influencing adoption and effectiveness of worksite wellness programs. Journal of Occupational and Environmental Medicine, 56(6), 579–587. https://doi.org/10.1097/JOM.0000000000000171.CrossRefPubMedPubMedCentralGoogle Scholar
- McLellan, D., Moore, W., Nagler, E., & Sorensen, G. (2017a). Implementing an integrated approach: Weaving employee health, safety, and well-being into the fabric of your organization. Retrieved from http://centerforworkhealth.sph.harvard.edu
- McLellan, D., Moore, W., Nagler, E., & Sorensen, G. (2017b). Implementing an integrated approach: Weaving employee health, safety, and well-being into the fabric of your organization. Retrieved from http://centerforworkhealth.sph.harvard.edu/guidelines
- Newman, L. S., Stinson, K. E., Metcalf, D., Fang, H., Brockbank, C. V., Jinnett, K., et al. (2015). Implementation of a worksite wellness program targeting small businesses: The Pinnacol assurance health risk management study. Journal of Occupational and Environmental Medicine, 57(1), 14–21. https://doi.org/10.1097/JOM.0000000000000279.CrossRefPubMedPubMedCentralGoogle Scholar
- NIOSH. (2016). Fundamentals of total worker health approaches: Essential elements for advancing worker safety, health, and well-being. By Lee MP, Hudson H, Richards R, Chang CC, Chosewood LC, Schill AL, on behalf of the NIOSH Office for Total Worker Health. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. DHHS (NIOSH) Publication No. 2017–112.Google Scholar
- NIOSH. (2017a). NIOSH Total Worker Health Affiliate Program. Retrieved from https://www.cdc.gov/niosh/twh/affiliate.html.
- NIOSH. (2017b). What is Total Worker Health? Retrieved from https://www.cdc.gov/niosh/twh/default.html.
- Nobrega, S., Kernan, L., Plaku-Alakbarova, B., Robertson, M., Warren, N., Henning, R., & Team, C.-N. R. (2017). Field tests of a participatory ergonomics toolkit for total worker health. Applied Ergonomics, 60, 366–379. https://doi.org/10.1016/j.apergo.2016.12.007.CrossRefPubMedPubMedCentralGoogle Scholar
- Ohio Bureau of Workers' Compensation. (2017). Safety grants. Retrieved from https://www.bwc.ohio.gov/employer/services/SandH/SafetyGrants.asp.
- Punnett, L., Warren, N., Henning, R., Nobrega, S., Cherniack, M., & Research Team, C. P. H.-N. E. W. (2013). Participatory ergonomics as a model for integrated programs to prevent chronic disease. Journal of Occupational and Environmental Medicine, 55(12 Suppl), S19–S24. https://doi.org/10.1097/JOM.0000000000000040.CrossRefPubMedGoogle Scholar
- SAIF Corporation. (2017). Total worker health. Retrieved from https://www.saif.com/safety-and-health/topics/promote-health.html.
- Schein, E. H. (2010). Organizational culture and leadership. San Francisco: Jossey-Bass.Google Scholar
- Schneider, B. (1975). Organizational climates: An essay. Personnel Psychology, 28(4), 447–479. https://doi.org/10.1111/j.1744-6570.1975.tb01386.x.CrossRefGoogle Scholar
- Schofield, K. E., Alexander, B. H., Gerberich, S. G., & MacLehose, R. F. (2017). Workers' compensation loss prevention representative contact and risk of lost-time injury in construction policyholders. Journal of Safety Research, 62(Supplement C), 101–105. https://doi.org/10.1016/j.jsr.2017.06.012.CrossRefPubMedGoogle Scholar
- Schwatka, N., Smith, D., Weitzenkamp, D., Atherly, A., Dally, M., v.S. Brockbank, C., Tenney, L., Goetzel, RZ., Jinnett, K., McMillen, J., & Newman, L. (in press). The impact of worksite wellness programs by size of business: A three-year longitudinal study of participation, health benefits, absenteeism, and presenteeism. Annals of Work Exposures and Health.Google Scholar
- Sirota, D., Mischkind, L., & Meltzer, M. (2005). The enthusiastic employee: How companies profit by giving workers what they want. Upper Saddle River: Wharton School Publishing.Google Scholar
- SmartMarket Report. (2017). Safety management in the construciton industry 2017. Retrieved from Dodge Data & Analytics: https://www.cpwr.com/sites/default/files/publications/Dodge_Safety_Report_2017.pdf.
- Sorensen, G., Barbeau, E., Stoddard, A., Hunt, M., Kaphingst, K., & Wallace, L. (2005). Promoting behavior change among working-class, multiethnic workers: Results of the healthy directions—Small business study. American Journal of Public Health, 95(8), 1389–1395. https://doi.org/10.2105/AJPH.2004.038745.CrossRefPubMedPubMedCentralGoogle Scholar
- Sorensen, G., McLellan, D., Dennerlein, J., Pronk, N., Allen, J., Boden, L., et al. (2013). Integration of health protection and health promotion: Rationale, indicators, and metrics. Journal of Occupational and Environmental Medicine, 55(12 Suppl), S12–S18. https://doi.org/10.1097/JOM.0000000000000032.CrossRefPubMedPubMedCentralGoogle Scholar
- Sorensen, G., McLellan, D., Sabbath, E., Dennerlein, J., Nagler, E., Hurtado, D., et al. (2016). Integrating worksite health protection and health promotion: A conceptual model for intervention and research. Preventative Medicine, 91, 188–196. https://doi.org/10.1016/j.ypmed.2016.08.005.CrossRefGoogle Scholar
- United States Census Bureau. (2016). Statistics of U.S. businesses main. Retrieved from http://www.census.gov/data/tables/2014/econ/susb/2014-susb-annual.html.
- Zohar, D. (2011). Safety climate: Conceptual and measurement issues. In J. C. Quick & L. E. Tetrick (Eds.), (2nd ed.). Handbook of occupational health psychology. Washington DC: APA.Google Scholar