Organizational practices, work demands and the well-being of employees: a follow-up study in the metal industry and retail trade

BACKGROUND: Rapid technological change and increased international competition have changed working life and work organizations. These changes may not be considered when researching employee work ability and well-being. AIM: This study investigates the impact of organizational practices, work demands and individual factors on work ability, organizational commitment and mental well-being of employees in the metal industry and retail trade. METHOD: A follow-up study was conducted to examine these connections among 1389 employees (mean age 42 years at baseline) in 91 organizations. The first survey was conducted in 1998 and was repeated in 2000. RESULTS: Changes in organizational practices and the demands of work were strongly associated with changes in employee well-being. Work ability, organizational commitment and the mental well-being of employees were increased most if the opportunities for development and influence and the promotion of employee well-being were increased and if the supervisory support and organization of work were improved. Well-being also improved with less uncertainty at work and with decreasing mental and physical work demands. In addition physical exercise and affluence also had favourable effects. CONCLUSIONS: The results confirm that several features of organizational practices are strongly associated with employees' well-being. Organizational development is an important method of improving employees' work ability, commitment and well-being.     

Results of employee involvement in planning and implementing the Treatwell 5-a-Day work-site study.

When work-site health promotion programs incorporate theories of community organization, it is likely that employee ownership and participation are enhanced. This article reports quantitative indicators of involvement of Employee Advisory Board (EAB) members in the Treatwell 5-a-Day work-site study and examines relationships between EAB member time spent on project activities and work-site size, with indicators of the extent of implementation and variables associated with behavior change and work-site support. The results reported here indicate that a greater number of EAB member hours spent on program activities was associated with a greater number of events implemented. Smaller work-site size was associated with greater employee awareness of the program and greater participation in project activities as reported on the employee survey. These results suggest that the number of hours employee representatives devote to project activities might be an important consideration in planning employee involvement in work-site health promotion programming.     

The impact of a prospective survey-based workplace intervention program on employee health, biologic stress markers, and organizational productivity

OBJECTIVE: To study whether knowledge about psychosocial work indicators and a structured method to implement changes based on such knowledge comprise an effective management tool for enhancing organizational as well as employee health and well-being. METHODS: White- collar employees representing 22 different work units were assessed before and after a 1-year intervention program. Subjective ratings on health and work environment, biologic markers, absenteeism, and productivity were measured. RESULTS: Significant improvements in performance feedback, participatory management, employeeship, skills development, efficiency, leadership, employee well-being, and work-related exhaustion were identified. The restorative hormone testosterone increased during the intervention and changes correlated with increased overall organizational well-being. Absenteeism decreased and productivity improved. CONCLUSIONS: Fact-based psychosocial workplace interventions are suggested to be an important process for enhancing employee well-being as well as organizational performance.     

Take heart: results from the initial phase of a work-site wellness program.

OBJECTIVES. The purpose of this study was to evaluate the short-term effects of a low-intensity work-site heart disease risk reduction program using a matched pair design with work site as the unit of analysis. METHODS. Twenty-six heterogeneous work sites with between 125 and 750 employees were matched on key organization characteristics and then randomly assigned to early or delayed intervention conditions. Early intervention consisted of an 18-month multifaceted program that featured an employee steering committee and a menu approach to conducting key intervention activities tailored to each site. RESULTS. Cross-sectional and cohort analyses produced consistent results. At the conclusion of the intervention, early and delayed intervention conditions did not differ on changes in smoking rates, dietary intake, or cholesterol levels. There was considerable variability in outcomes among work sites within each condition. CONCLUSIONS. Despite documented implementation of key intervention activities and organization-level changes in terms of perceived support for health promotion, this intervention did not produce short-term improvements beyond secular trends observed in control work sites. Research is needed to understand determinants of variability between work sites.     

Quality assessment in worksite health promotion.

The rapid expansion of worksite health promotion programs and the proliferation of service providers have resulted in increased concern about the quality of such programs. And while employers may view health promotion programs as a service to be purchased, in general, quality standards, price, and outcomes are less well established for primary prevention programs than for other medical services. This trend creates substantial potential for inappropriate expenditures, undermining the general credibility of such programs. Recognizing the limits of epidemiologic data and the potential for misuse of health promotion activities in the workplace, the California Department of Health Services (CDHS) undertook the development of guidelines for employers' use in assessing the quality of the numerous employee health promotion or chronic disease risk reduction programs available to them. To make the use of such programs as productive as possible, the CDHS developed recommendations in two main areas: (1) general recommendations for six fundamental program planning and development activities that underlie sound health promotion programs, and (2) specific criteria for seven types of health promotion programs commonly implemented in work settings. Optimally, worksite-based health promotion programs should be part of a comprehensive effort that provides for appropriate medical oversight, referral, and follow-up procedures. These programs should be complemented by appropriate changes in the work environment and in organizational policies. Programs should also include strategies to assist employees in initiating healthier behaviors and maintaining the new behaviors once they are established. Preventive medicine and occupational medicine practitioners and medical directors should be familiar with the issues addressed by these recommendations.     

Implementation and outcomes of a comprehensive worksite health promotion program

BACKGROUND: This paper reports on the implementation and results of a three-year comprehensive worksite health promotion program called Take care of your health!, delivered at a single branch of a large financial organization with 656 employees at the beginning of the implementation period and 905 at the end. The program included six educational modules delivered over a three-year period. A global health profile was part of the first and last modules. The decision to implement the program coincided with an overall program of organizational renewal. METHODS: The data for this evaluation come from four sources: analysis of changes in employee health profiles between the first and last program sessions (n=270); questionnaires completed by participating employees at the end of the program (n=169); organizational data on employee absenteeism and turnover; and qualitative interviews with company managers (n=9). RESULTS: Employee participation rates in the six modules varied between 39% and 76%. The assessment of health profile changes showed a significant increase in the Global Health Score. Participants were significantly more likely to report more frequent physical activity and better nutritional practices. The proportion of smokers among participants was significantly reduced (p = 0.0147). Also reduced significantly between the two measurements were self-assessment of high stress inside and outside the workplace, stress signs, and feelings of depression. Employees were highly satisfied with the program and felt that it had impacts on their knowledge and capacities to manage their health behaviour. During the same period, absenteeism in the organization declined by 28% and turnover by 54%. From the organization's perspective, program implementation was very successful. CONCLUSIONS: This study's results are in line with previous findings of significant benefits to organizations and employees from worksite health promotion. The close relationship between the program outcomes and the overall process of organizational renewal that it accompanied supports previous arguments that worksite health promotion will be most effective when it promotes overall organizational health.     

Employer Role in Integrative Workplace Health Management

The health of the international workforce has been an increasing area of concern for the last two decades. Globalization of the world economy and rapid technological changes continue to change the nature of work and employment practices, exposing employees to new and serious health risks. These challenges are inescapable in any workplace, therefore it is important that employers examine how they can best fulfill their legal and leadership roles to protect and promote the health and well-being of their employees.This paper explores employer roles in employee health in the context of global and local challenges. A strategy is suggested for employers to deal with the multifaceted workplace pressures and health impacts on employees i.e. implementing an integrative holistic model of workplace health management (workplace health management is an approach to workplace health that includes health promotion, disease prevention, safety management and organizational development). Workplace health management has emerged from the latest developments in the settings approach to workplace health promotion.The changing world of work and the implications on employee health in the current climate of globalization and technological changes is also examined. In particular, it highlights mental health issues associated with the emerging epidemic of work stress from increased workplace pressures.The paper reviews the changing conceptions of the role of employers and contemporary approaches to management practices in a range of disciplines, drawing out the common principles and strategies to respond to changes. One essential message which has emerged from the review is that employers need to become change agents and visionary leaders who adopt a proactive, interdisciplinary and integrative system approach to formulate and develop company policies and workplace culture that facilitates employee participation, professional growth and team work.These contemporary management principles and strategies form the basis of the integrative model for workplace health management presented in this paper. In essence, the integrative model of workplace health management uses a participatory problem solving cycle to identify and address the numerous issues associated with health promotion and disease prevention, occupational safety and hazard reduction, and organizational improvement and human resource management. Specifically this involves the employees and employer participating in a needs-based program development and implementation cycle: identifying health priorities and addressing environmental, organizational, occupational and lifestyle determinants of employee health. The paper concludes with an overview of international development of workplace health management and reports on successful examples from European, Western Pacific and Pan American regions.     

Factors influencing the adoption and maintenance of Canadian, facility-based worksite health promotion programs

PURPOSE. The purpose of this study was to determine senior management's rationale for adopting and maintaining worksite health promotion programs and the congruence of this rationale with the program objectives of health professionals who manage the programs. DESIGN. A multiple case study design was used. SETTING. Nine major Canadian organizations which had adopted facility-based health promotion programs were the settings for this study. DATA COLLECTION. Semi-structured interviews (22 conducted) and two questionnaires (36 completed) were the methods used to collect data. RESPONDENTS. Senior managers involved in program adoption, senior managers responsible for program budgets, and senior health professionals responded to the interviews and questionnaires. RESULTS. Impetus for health promotion program adoption in the organizations we studied had more to do with tangential issues such as an organization moving to a new facility or having access to unused space than with employee health or organizational performance considerations. The most common program adoption rationale was related to employee recruitment/retention. Program continuance was based on process issues such as participation rates and the quality of activity offerings rather than on health or organizational outcomes. While health professionals and senior management both considered human relations and morale more important than cost savings outcomes, health professionals considered cost savings outcomes more important than did senior management. CONCLUSIONS. It is important for health promotion professionals to develop program objectives which are shared by organizational management. Future program adoptions and maintenance will be influenced by closer analyses of the effect of these programs on organizational performance.     

A review of health-related outcomes of multi-component worksite health promotion programs

PURPOSE: The purpose of this article is to critically review evaluation studies of the health-related effects (i.e., health risk modification and reduction in worker absenteeism) of multicomponent worksite health promotion programs. SEARCH METHOD: A comprehensive literature search conducted under the auspices of the Centers for Disease Control and Prevention identified 36 articles that examined health-related outcomes of multi-component programs. The authors identified 11 additional articles through manual searches of recent journal issues and through personal contacts with worksite health promotion researchers. Forty-seven studies describing the results of 35 worksite health promotion programs were reviewed. IMPORTANT FINDINGS: The worksite health promotion programs reviewed for this article varied tremendously in the comprehensiveness, intensity, and duration of the intervention activities. All of the programs provided health education to employees. In a majority of the programs, opportunities to learn and practice new skills were also offered. A smaller number of programs incorporated modifications in organizational policy or the physical work environment. Results from well-conducted randomized trials suggest that providing opportunities for individual risk reduction counseling for high risk employees within the context of comprehensive programming may be the critical component of an effective worksite health promotion program. Just offering low intensity, short duration programs aimed at increasing awareness of health issues for the entire employee population may not be sufficient to achieve desired outcomes. MAJOR CONCLUSIONS: The results of the studies reviewed provide both cautious optimism about the effectiveness of these worksite programs and some general guidance as to the critical components and characteristics of successful programs. Overall, the evidence suggests that a rating of indicative/acceptable may best characterize this literature.     

Worksite health promotion programs in the United States: progress, lessons and challenges

Worksite health promotion programs have become increasinglyprevalent in the United States, and one or more health promotionprograms are found in two-thirds of all private worksites with50 or more employees. Reasons for recent growth in program frequencyinclude increased concern for worker health, rapidly escalatingemployer payments for health care benefits to workers, and growingevidence of a strong linkage between employee health and productivity.Published results of evaluations to date suggest that worksitehealth promotion programs can have positive impacts on healthbehaviors and health status. In addition, economic analysesare suggesting that some programs can affect the slope of healthcare costs and have the potential of high cost-effectivenesscompared to some clinical interventions. A number of researchchallenges remain, particularly understanding the influencesof the worksite environment and how employee health promotionprograms affect individual and organizational productivity.     

Risk factors in health, work environment, smoking status, and organizational context for work disability

BACKGROUND: This study examines the associations between health, work environment exposures, smoking status, and organizational context and work disability. METHODS: In a sample of 3,318 Danish employees, respondents were interviewed by telephone in 1995 about health, work environment, smoking status and organizational context of the workplace. In 1997, a follow-up to assess employment status was conducted using The Statistical Register of Transfer Payments, Statistics Denmark. RESULTS: Work disability is predicted by work environment, smoking status of the individual employee, and by organizational level factors at the workplace. Although poor mental health, chronic bronchitis or musculoskeletal symptoms in neck or shoulders were equally distributed at baseline among type of company, the 2-year incidence of work disability was higher in traditionally organized workplaces than in flexibly organized workplaces. CONCLUSION: The study suggests a potential for reducing health-related work disability from work through flexible organization of the workplace.     

Wellness in the work place: potentials and pitfalls of work-site health promotion

In the past decade work-site health promotion programs have been developed by many American corporations. Although the potential for these programs to improve worker health and productivity is appealing, there is yet only limited data on their effectiveness or their pitfalls. Evaluation of the benefits of work-site health promotion must consider the sociopolitical context as well as cost-containment outcomes.     

Financial incentives, participation in employer-sponsored health promotion, and changes in employee health and productivity: HealthPlus Health Quotient Program

Employer-sponsored health promotion can improve employee health and morale and reduce medical claims and absenteeism. Effectiveness depends on the participation of those employees who are at increased risk of ill health. HealthPlus Health Quotient is an incentive/disincentive approach to health promotion. The employer's contribution to the employee cafeteria-plan benefit package is adjusted on the basis of an annual health risk appraisal. We evaluated whether this financial incentive/disincentive predicted participation in health promotion activities, and whether participation improved future health risk and productivity. In the first year, participation was proportional to overall health risk (P < 0.01). Participation in targeted programs was proportional to levels of body fat, cholesterol, and blood pressure. Participation in activity-related health promotion was proportional to prior-year activity or fitness scores. Health promotion participants improved their subsequent-year health risk more than did non-participants. Participation was associated with reduced illness-related absenteeism and (although inconsistently) with medical claims paid and short-term disability.     

The Healthy Worker Project: a work-site intervention for weight control and smoking cessation.

OBJECTIVES. A randomized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking. METHODS. Thirty-two work sites were randomized to treatment or no treatment for 2 years. Treatment consisted of health education classes combined with a payroll-based incentive system. Evaluation was based on cohort and cross-sectional surveys. RESULTS. Of 10,000 total employees in treatment work sites, 2041 and 270 participated in weight control and smoking cessation programs, respectively. Weight losses averaged 4.8 lbs, and 43% of smoking participants quit. Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0% and 2.1% in cross-sectional and cohort surveys, respectively. No treatment effect was found for weight. Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs (r = .45 for smoking and r = .55 for weight). CONCLUSIONS. This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile.     

Workplace health promotion and employee health in Swedish municipal social care organizations

Aim

The aim of this explorative study was to investigate the employers’ management characteristics, their provision of workplace health promotion (WHP) measures, and employee satisfaction with WHP in relation to employee health in Swedish municipal social care organizations.

Subjects and methods

A cross-sectional design was used, and questionnaires were sent to top managers (representing the employer) and employees in a nationwide random sample of 60 of the 290 municipal organizations for the social care of elderly and disabled people in Sweden. The questionnaire data from the 60 managers were linked to aggregated employee data concerning self-rated health and satisfaction with WHP from a representative sample of 8,082 employees in the same organizations. All analyses were performed at the organizational level using independent t-test, Spearman’s rank correlation and multiple linear regression analysis.

Results

In the multivariate analysis, the organizational WHP index (i.e. local WHP projects and WHP coordinators), individual WHP index (i.e. health profile assessment, fitness activities and medical check-up), and the level of employees’ satisfied with WHP were associated with employee health (F?=?9.64, p?<?0.001, adjusted R ²?=?0.48). General organizational and management characteristics were, however, not statistically related to employee health.

Conclusion

The results suggest that the provision of individual-directed and organizational-directed health-specific measures were related to employee health in Swedish municipal social care organizations and, therefore, can be part of a comprehensive approach to address WHP.     

Job decision latitude, organizational justice and health: multilevel covariance structure analysis

A total of 2969 hospital employees from 162 wards participated in a 2-year follow-up study that examined the relationship between job decision latitude, organizational justice and employee health in Finland. We used medically certified sickness absence records as indicators of health problems. Multilevel covariance structure analysis was applied to take into account the hierarchical nature of the data. Responses from individuals within work units seem not always to be independent, and any models that ignore this lack of independence may incorrectly estimate the between individual relationships. Our results suggest that both job decision latitude and organizational justice varied considerably between work units in addition to individual level variation. Furthermore job decision latitude was associated with organizational justice both at individual and work unit level. Justice evaluations predicted sickness absence only at the individual level.     

The shape up challenge: a community-based worksite exercise competition

PURPOSE: To assess organizational and employee participation during three community-wide worksite exercise competitions in two communities. DESIGN: A one-group, posttest-only design was used. Lack of controls, exercise baseline, and the short-term nature of the interventions were limitations. SETTING: The Minnesota Heart Health Program conducted annual exercise campaigns between 1982 and 1989 within three intervention communities to reduce behavioral risk for cardiovascular disease. The Shape Up Challenge was a worksite exercise competition designed, in conjunction with other campaign activities, to increase levels of physical activity. SUBJECTS: A total of 119 participating companies in two Minnesota communities, and 17,626 employees within these worksites, composed the subjects in this study. INTERVENTION: Eligible worksites were invited to participate in a month-long competition during which employees recorded minutes spent daily in aerobic activities. Incentives were established to promote intragroup cooperation and intergroup competition. Companies competed for awards that were based on average minutes of exercise per employee versus per participant. MEASURES: Numbers of companies recruited and participating, campaign activities, minutes of exercise, and costs were recorded on implementation logs. Companies completed surveys describing business type, number and sex of employees, existing health promotion programs, and perceived benefits of participation. RESULTS: Of the 365 companies invited to participate, 33% participated (range 15% to 50%). Participating companies were more likely than nonparticipating companies to offer other health promotion programs and perceived greater benefits from participation. Women and smaller companies had significantly greater participation rates than men and larger companies. Average employee participation rates ranged from as high as 84% in smaller organizations to as low as 16% as organization size increased. CONCLUSIONS: Community-based worksite exercise competitions appear to be a viable strategy for promoting employee exercise, particularly in smaller companies. Group-based contingencies applied in natural work units may facilitate employee participation. Further research is needed to assess the relative efficacy of this approach, compare alternative incentives, and identify strategies to enhance exercise maintenance after the intervention has ceased.     

Employee violence in health care: guidelines for health care organizations

Workplace violence is increasing, and health care environments are not immune to this escalating public health problem. In order to prevent or diminish the risk of a violent episode in the health care setting committed by employees, former employees, or family/significant others, health care managers need to be cognizant of certain factors associated with violence in the workplace. These variables include employee characteristics and behavior patterns, coworker indicators, organizational policies and procedures, mentally impaired employees, and so forth. Prevention strategies, use of employee assistance programs, managerial responses in escalating situations, impact of the Americans with Disabilities Act, and postviolence interventions must also be considered as part of progressive health care system administration, relative to the phenomenon of workplace violence.     

Health programmes for school employees: improving quality of life, health and productivity

School health programmes in the 21st century could include eight components: 1) health services; 2) health education; 3) healthy physical and psychosocial environments; 4) psychological, counselling, and social services; 5) physical education and other physical activities; 6) healthy food services; and 7) integrated efforts of schools, families, and communities to improve the health of school students and employees. The eighth component of modern school health programmes, health programmes for school employees, is the focus of this article. Health programmes for school employees could be designed to increase the recruitment, retention, and productivity of school employees by partially focusing each of the preceding seven components of the school health programme on improving the health and quality of life of school employees as well as students. Thus, efforts to improve the quality of life, health, and productivity of school employees may be distinct from, but integrated with, efforts to improve the quality of life, health, and education of students. School employee health programmes can improve employee: 1) recruitment; 2) morale; 3) retention; and 4) productivity. They can reduce employee: 5) risk behaviours (e.g., physical inactivity); 6) risk factors (e.g., stress, obesity, high blood pressure); (7) illnesses; 8) work-related injuries; 9) absentee days; 10) worker compensation and disability claims; and 11) health care and health insurance costs. Further, if we hope to improve our schools' performance and raise student achievement levels, developing effective school employee health programmes can increase the likelihood that employees will: 12) serve as healthy role models for students; 13) implement effective school health programmes for students; and 14) present a positive image of the school to the community. If we are to improve the quality of life, health, and productivity of school employees in the 21st century: school administrators, employees, and policymakers must be informed about the need and the means to do so; school employee health programmes must become part of the culture of education and the expectation of educators; and colleges that prepare school administrators and other school employees must provide the pre-service and in-service training, research, development, and leadership to make it happen. This article outlines ten actions that can be taken by school districts to build or improve school employee health programmes, and a list of websites that provides more detailed information about such programmes.