Bring a culture of health to health care
An opportunity to lower costs, improve health
The quest to reduce both injuries and medical costs is leading hospitals to turn their health-driven mission toward their own employees.
A growing body of research shows that it’s more effective to integrate the dual goals of occupational health and health promotion rather than have separate programs for injury prevention and wellness. “Total Worker Health” is now the focus of the National Institute for Occupational Safety and Health (NIOSH).
“The health of workers is not something that is clearly delineated between work and home,” says L. Casey Chosewood, MD, senior medical officer for the Total Worker Health initiative. “When you improve someone’s health away from work, they’re going to perform better at work. If you improve their work environment, they’re going to have a better health and lifestyle away from work.”
Employers have a financial stake in keeping their workers healthy, whether to lower workers’ compensation costs or medical claims. They can address those issues jointly, Chosewood says.
“It can improve productivity. It can lower injury and illness rates,” he says. “We have evidence that when you integrate programs, you have higher engagement and participation in both programs.”
The American College of Occupational and Environmental Medicine (ACOEM) also promotes integration in a guidance document issued last year. “Today’s best evidence indicates that the aims of both health protection and health promotion interventions are best achieved when they are working in concert,” ACOEM stated.1
Using hospital resources
Despite high rates of musculoskeletal disorders and other injuries, health care has traditionally lagged behind other sectors in its focus on worker safety. But when it comes to integrating occupational health and wellness, hospitals are leading the way.
“Health care, like any other business, is suffering from increased health care costs [of employees],” says Robert McLellan, MD, MPH, chief of Occupational and Environmental Medicine for
Dartmouth-Hitchcock Medical Center in Lebanon, NH. “Health care organizations also have resources that they can immediately turn inwards and apply to themselves.”
Some hospitals are trying to reform the work environment to make it easier to make healthy lifestyle choices. They are revising their cafeteria choices, stocking vending machines with healthy foods, and creating walking paths.
At Dartmouth-Hitchcock, programs that address workplace hazards also incorporate personal health. For example, an ergonomics program that promotes safe patient handling also encourages employees to be more physically active. It looks at work schedules and other elements of the work environment, says McLellan, past president of ACOEM and a member of the workgroup that developed the ACOEM guidance. (See related story, page 103.)
“If you’ve got a lot of back injuries, the traditional safety approach is that you need lift equipment,” says McLellan, who is also medical director of the LiveWell/WorkWell program. “The integrated approach says, ‘Let’s do a 360-degree assessment and see all the things going on here. What are the shifts? What’s the nutritional environment? How is work organized? What’s the social environment? How engaged are they in the work? How do they feel about leadership?”
Research shows that integrated programs result in better worker engagement in safety and better health behaviors.1 There are also more subtle interactions at play, notes Glorian Sorensen, PhD, MPH, principal investigator of the Harvard School of Public Health Center for Health and Wellbeing, a research center funded by NIOSH.
“I may feel if I’m working really hard and I’m hurting my back, it’s going to be hard to be physically active,” says Sorensen, who is also professor of society, human development and health at Harvard University in Cambridge, MA, and director of the Center for Community-based Research at the Dana Farber Cancer Institute in Boston. “Those changes in ergonomic practices that may be likely to reduce the potential for pain might actually result in feeling like you can be more physically active.”
SafeWell guides health care
The change in perspective may begin by coordinating employee health and health promotion and placing them in the same organizational group. A comprehensive approach builds support from leadership and supervisors, engages employees, and monitors effectiveness.
The new approach will likely require policy changes. For example, hospital leadership may look at break policies to make sure employees are taking adequate breaks and at scheduling to give employees some flexibility to maintain a work-life balance, says Sorensen. Work scheduling can affect diet and exercise, she says.
The SafeWell Practice Guidelines provide a roadmap specifically for health care organizations. Created through collaboration between the Harvard School of Public Health Center for Work, Health and Well-being and Dartmouth-Hitchcock Health Care, they provide implementation steps and tools to build a program. (See checklist, page 102.)
SafeWell recommends creating an employee advisory board, which would meet once a month and provide input from various departments and employee groups. The key is “making sure across the different groups of workers there is a sense of representation and having a voice,” says Sorensen.
The guidance includes an assessment of safety and compliance with U.S. Occupational Safety and Health Administration regulations as well as personal health assessments for employees.
Creating a healthier workplace becomes even more important as the workforce ages, says Chosewood. The physical changes of aging have an impact on injury risk as well as personal health.
“Half of all workers over the age of 40 come to work with muscular and joint pain,” he says. “If you look at workers over the age of 55, almost half have clinically diagnosed arthritis. They’ve had the symptoms long enough or severe enough to have a diagnosis.”
Arthritis may put employees at greater risk of injury, he says. “Imagine an ergonomics program that doesn’t just look at risk in the workplace but addresses joint pain and arthritis prevention tips,” he says.
VHA tests new approach
Some models for integrating occupational health and health promotion are emerging, and they are showing signs of success.
The Veterans Health Administration (VHA) launched a three-year pilot program in 14 Midwest hospitals, with programs that focused on personal health issues and coordinated with occupational health.
“We want to create an environment where health is nurtured and to provide the tools and the resources that our employees need to make the right choices regarding their health,” says Ebi Awosika, MD, MPH, director of the VHA Employee Health Promotion Disease and Impairment Prevention Program in the Occupational Health Strategic Healthcare Group.
For example, some employees who spend much of their day at their desks were given treadmill desks to improve their physical activity, says Awosika. They were able to walk while they worked. Some hospitals made stairwells more attractive and created walking groups. Trained coaches also provided exercises for injured employees with a goal of helping them return to work more quickly, she says.
The Employee Assistance Program worked together with the violence prevention team, with an emphasis on stress management. A 12-week weight management program resulted in an average weight loss of five pounds, Awosika says. The smoking cessation program, which included nicotine replacement therapy, had a 20% quit rate after one year.
“When you think about total worker health, it’s not just integrating with occupational health but looking at the whole environment, the total health of the employee,” she says.
The health promotion efforts led to lower absenteeism and fewer personal health risks. The hospitals developed effective and innovative programs with mini-grants, she says. “I continue be amazed with what people can do with a small amount of dollars,” Awosika says.
Integrated health programs also can lead to better retention and recruitment of employees, says Chosewood. “Folks are ready for solutions that lower costs and improve health,” he says. “We believe this is an opportunity to do both.”
Editor’s note: More information about NIOSH’s Total Worker Health initiative is available at www.cdc.gov/niosh/twh. The SafeWell Practice Guidelines are available from the Harvard School of Public Health Center for Work, Health and Well-being at http://ow.ly/d2lgD
Reference
1. Hymel PA, Loeppke RR, Baase CM et al., Workplace health protection and promotion: A new pathway for a healthier – and safer – workforce. J Occup Environ Med 2011; 53:695-702.
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