This blog post is adapted from Suzanne Nobrega's presentation of the same name, given at AIHce EXP 2020. It was edited by Abby Roberts, editorial assistant at The Synergist.

A Total Worker Health (TWH) program flourishes when it is supported by all levels within the organization, from senior leaders, to middle managers, to frontline workers. One of the core concepts of a TWH approach is designing work and the workplace to remove hazards while also promoting well-being. To assess and improve work design, IHs need to know how workers see their job tasks and work organization.

Yet workers are often overlooked when it comes to making decisions about safety and health initiatives. Changes implemented from the top down often fail to address the root causes of problems or have unintended effects on frontline workers. These unintended consequences can create new problems, hampering adoption of the new safety and health initiatives. On the other hand, workers understand the realities of the work they perform every day. They understand how work processes are designed and arranged as well as what causes a problem and how to address it. That is why promotion of worker engagement is NIOSH’s third fundamental element of a successful TWH program.

Employee participation within a TWH program is necessary to improve work design, to change behaviors, to make decisions about what and how problems need to be addressed, and to ensure workers support each other during the transition toward better safety and well-being. Knowledge from the employees’ experiences helps the IH discover the root causes of physical, social, and mental stress and unhealthy behaviors, and to place solutions in context. The Healthy Workplace Participatory Program (HWPP) is a toolkit developed by CPH-NEW for encouraging employee participation in workplace safety programs, which can be adapted for a TWH approach.

The HWPP Toolkit

The HWPP is based on three components: a two-committee structure consisting of a design team of frontline workers and a steering committee of managers; a facilitator to moderate between them; and the IDEAS tool, a step-by-step framework for planning an intervention. The steering committee provides resources, oversees the program, and helps support the implementation of new procedures, while the design team identifies health concerns and their root causes, designs solutions, and proposes them to the steering committee. It is important that design team members know the work process and are interested in worker well-being. The facilitator, who may be an occupational health professional, safety manager, or union safety leader, coordinates work between the two teams and eases communication.

The HWPP uses a participatory design process that engages the steering committee and the design team in creating interventions that apply principles of Total Worker Health. This design process is called “IDEAS,” an acronym for Intervention, Design, and Analysis Scorecard. It contains seven steps:

1. Identify root causes.
2. Develop objectives and activities.
3. Set selection criteria.
4. Apply selection criteria.
5. Rate and select intervention alternatives.
6. Plan and implement interventions.
7. Monitor and evaluate the intervention.

The HWPP includes information, guides, and handouts for each step of the IDEAS process. IDEAS is research-based and field tested.

Boosting Engagement During Safety Meetings

Meetings are the most common way of engaging people in planning, implementing, and evaluating safety and well-being initiatives. While meetings in general have an uninspiring reputation, you can take steps to engage the participants, both at the managerial and frontline levels.

Facilitative leadership of meetings can create the conditions for a team to function effectively. Facilitative leaders take steps to engage workers, get them involved, and collect their input in all phases of program design and implementation. Sometimes this can be accomplished with brainstorming sessions and other team planning activities. Facilitators ensure that all team members feel comfortable sharing ideas and help people consider opposing viewpoints, often by establishing and enforcing ground rules for how the team operates and how the members communicate with each other. The HWPP also includes resources such as videos and a manual for training facilitators in best practices for meeting facilitation.

A well-designed meeting can produce a great experience. A poorly planned one can produce frustration and disengagement. Some key meeting design elements used in the HWPP toolkit are meeting objectives, meeting activities, and time stamps. The meeting objectives tell participants why they are there and what will be accomplished. This engages meeting participants because they feel their time is being well spent. Each meeting topic should correspond to a meeting objective. For each meeting topic list the activities you will use to cover that topic. This tells attendees how they will participate, and time stamps tell them exactly when each activity will occur.

When you use these meeting design elements, attendees are more likely to leave feeling productive and motivated. Successfully engaging workers in a TWH initiative will help the safety initiative to flourish.

Other Tips and Tools for Promoting Worker Engagement

Build employee engagement into your IH practice by creating opportunities for employees to help you solve problems. You can form teams—such as Design Teams, following the HWPP toolkit—for sustained involvement around an issue. Another approach is to make it a practice to ensure front-line employees are represented on existing committees that address work design and safety and health issues. Recognize, and encourage managers to recognize, employees who get involved.

You can also try to use idea boards. These are white boards placed in highly visible areas to invite workers to contribute their ideas. You can pose specific questions on your board and you can report back about input you received previously. Make the communication two way if possible. And finally, get worker feedback on workplace changes before rolling them out. Involving a small number of workers in a pilot run of a new process or piece of equipment can help you avoid pitfalls and result in better outcomes.

Promoting worker engagement is a foundational concept of a Total Worker Health approach. Better worker engagement is an indicator of excellent safety culture and better workplace outcomes for safety, health, and well-being.

Resources

Annals of Work Exposures and Health: "Defining ‘Integration’ for Total Worker Health: A New Proposal" (April 2020).

Fundamentals of Total Worker Health Approaches

Healthy Workplace Participatory Program