This post is adapted from a presentation given by Charles Redinger at AIHce EXP 2020 and from a conversation with him that took place on Sept. 18, 2020.

This blog post elaborates on a topic touched upon in the Dec. 8, 2020 blog: the question of how, practically speaking, to convince your organization to implement policies that accord with Total Worker Health—and on the overlapping topic of how to build an organizational culture of health. Where the Dec. 8 blog post provided tips on introducing health and well-being initiatives to organizational leadership, this one covers concepts and tools that can help bring entire organizations on board with health as a value.

A culture of health exists when an organization maintains stakeholder health as a priority. All organizational members have less illness and fewer unhealthy behaviors; the organization totally and equally supports their health, safety, and well-being. Total Worker Health goals are most easily achieved when the entire organization supports health. In fact, cultures of health and TWH reinforce each other. Following the TWH framework may lead to a more robust culture of health.

Organizational Values and Shifts in Thinking

In the past, companies and businesses tended to concern themselves only with their financial bottom line: recovering costs and, if possible, making a profit. In recent decades, however, some organizations have drawn on a concept known as “the triple bottom line”—accounting for social and environmental debts in addition to financial ones—when formulating their vision and values. Companies are beginning to prioritize health, both out of a sense of social responsibility and a recognition that healthy employees are more productive.

You may understand this relatively new—as of roughly the last twenty years—shift in values as part of the organizational growth process. As organizations mature in risk management and global awareness, they gradually shift from being solely compliance-driven to performance-driven to impact-driven. In the initial “compliance-driven” stage, actions and decisions are mostly reactive: the organization (or a health and safety department within an organization) has limited safety and health goals beyond those that avoid penalization by following rules, laws, and regulations governing worker health and safety.

As the organization becomes more established and its mission evolves, it undergoes a collective shift in thinking and enters a proactive “performance-driven” stage. Here, IH/OEHS departments use systems thinking and formal management systems to drive productivity and improve worker health while maintaining compliance. After another shift in thinking, the organization enters a generative “impact-driven” stage. The fully mature organization embraces corporate citizenship and responsibility and reorients itself toward making the world a better place. In this stage, industrial hygiene professionals’ concerns expand beyond workers and encompass organizational, community, and global health.

You can visualize this process against a matrix with awareness maturity on the y-axis and EHS and risk management maturity on the x-axis (Figure 1).

Figure 1. A visualization of organizational or department maturity. From “Awareness-Based Risk Management: Seeing, Transforming, and Unleashing Organizational Capacity,” Institute for Advanced Risk Management, Harvard, Mass.

But how do companies move through these stages intentionally?

As mentioned above, two shifts in thinking occur between the three steps of organizational risk awareness and management maturity. The first occurs between the compliance-driven and performance-driven stage; the organization is often pressured toward this shift as NGOs grow in stature. A culture of health can bring about the second shift in organizational thinking. Total Worker Health policies may be a step toward organizational transformation.

The COH4B Framework and Other Tools

Using the risk management tools, frameworks, navigational aids, and tips for talking with leadership discussed in the Dec. 8 blog post can pilot an organization toward TWH. Another tool for measuring your organization’s commitment to health is the Culture of Health for Business (COH4B) framework (PDF), developed by the Global Reporting Initiative (GRI) with support from the Robert Wood Johnson Foundation (RWJF). You can use COH4B to evaluate an organization’s performance regarding its promotion of worker health, safety, and well-being. COH4B findings can also form the basis of TWH implementation.

COH4B recognizes five factors that contribute to a person’s health: physical environment, health services, biology and genetics, social environment, and individual behavior. Each of these factors is divided into multiple subcategories. The framework also recognizes four categories of sixteen total business practices, which the GRI/RWJF project asserts will demonstrably improve business performance and health indicators.

The COH4B framework is detailed enough to account for many workplace health indicators and measure health culture performance in multiple areas of concern. Only a summary is appropriate for this blog post, but the PDF linked above provides a complete guide to the tool. COH4B offers flexibility and experimentation, allowing an IH/OEHS program to develop the right health interventions for its organization. The COH4B project aims to build a culture of health through data reporting, integrated thinking, and cross-departmental action.

Long-Term Change

Unfortunately, most organizational change initiatives (health-related or otherwise) fail—this is why it is so valuable to develop a culture of health. Departmental or organizational culture will always override any strategy, policy, or initiative in the long term.

The slow pace of change doesn’t mean that you should not try to pursue Total Worker Health, but it does mean that you must find ways to “hold the change” over time, perhaps using frameworks such as COH4B to guide the process and management systems as the foundation. First, define your health vision for your organization and then identify what kinds of measurements and reporting you need to get there. At some point, you may have a chance to enroll or “sell” the leadership into the initiative. With the support of executives and management, you will find it easier to sustain health and safety changes until they become part of the culture.

Related: Read "The Journey to 'Be Well': Implementing Total Worker Health in Eugene, Oregon" in the Oct. 2019 issue of The Synergist.