Building healthy organizations takes more than simply putting in a wellness program

There is a mountain of research detailing the benefits of healthy work environments for employees and organizations.

We know healthy jobs and workplaces contribute to an individual’s physical, mental, spiritual and social well-being. We also know that a healthy workplace can result in higher job satisfaction, lower absenteeism and turnover, improved job performance, lower accident rates, and reduced health benefit and workers’ compensation costs.

Yet the evidence shows many working Canadians continue to suffer ill health, at least in part, because of what goes on at their jobs. We know healthy workplaces are good but many organizations struggle to create a healthy environment. Why is that? The main reason is that most organizations are treating the symptoms and not the underlying causes of poor employee health.

It is a positive sign that health promotion programs are becoming more widespread. Yet, they are just that — programs. The target of these programs is the individual rather than the underlying working conditions that affect health and wellness.

The trouble with only dealing with the symptoms of stress, ill-health and injury, is that the problems just keep coming back. Most workplace health promotion programs do not address the “upstream” causes of poor employee health and diminished productivity.

To move beyond this, practitioners need to approach creating a healthy organization as a process of organizational change rather than the introduction of a new program. This requires a strategy that pays careful attention to the change process.

The healthy organization

There is a consensus among occupational health and safety, workplace health promotion and epidemiological experts that successful interventions must target underlying workplace and organizational factors.

The Toronto-based Institute for Work and Health claims the limitations of workplace health promotion programs can be remedied by promoting the workplace determinants of health, which address job, organizational and work environment as causes of health and wellness. Other researchers use the concept of a “health-promoting workplace” to balance customer expectations, organizational goals, employee skills and health needs.

Scientists at the National Institute for Occupational Safety and Health (NIOSH), in the United States, define a healthy organization as “one whose culture, climate and practices create an environment that promotes employee health and safety as well as organizational effectiveness.” NIOSH emphasizes the importance of an organizational climate in which employees feel valued and are able to resolve group conflicts. Equally important are management practices that reward workers for quality work, supportive supervisors and strong leadership.

Reframing employee health in these broader organizational terms transforms it from the status of a policy or program into a core characteristic of how an organization operates.

The change process

Creating healthy organizations presents practical challenges regarding the change process.

Changing an organization’s ingrained values, priorities and work structures is much more difficult than simply encouraging a healthy lifestyle — although both may be needed.

Furthermore, while a fitness or smoking cessation program can be run by health promotion staff, transforming the values, practices and procedures of an organization requires the collaboration of health promotion and human resource professionals.

Equally crucial is the support of managers and supervisors at all levels, employees, and unions. This kind of systemic change requires clarity of vision, strong commitment, and a degree of co-operation and involvement usually not found in conventional work site health promotion programs.

Steps toward healthy organizations

Beyond these considerations, there are three key steps that serve as the basic building blocks of healthy organizations.

The first is a careful examination of the risk factors, or the underlying job characteristics and organizational conditions that enhance or impair health. The second step is to zero in on desired outcomes, in terms of employee health, organizational results, and broader societal impacts. The third is an identification of the actions required to address these underlying factors and achieve the desired outcomes.

All three steps are crucial, which calls for an integrated approach to building healthy organizations.

In terms of risk factors, a healthy organization strategy must address both job and workplace factors; though related, the two are distinct. Job factors include physical working conditions, ergonomic aspects of a job, temporal aspects of the work day and tasks, actual work content, job autonomy, co-worker relations, quality of supervision, financial and economic aspects. Workplace factors refer to organizational structures, work climate and culture, communications, management practices, leadership, labour-management relations, existing workplace health promotion and occupational health and safety activities.

Outcomes will vary by the scope and objectives of the intervention. These may include improved individual health, which yields returns on the investment in a particular health promotion program (for more on this topic see my Sept. 23, 2002 column or go to www.hrreporter.com click on “Search” and enter article #2064). Reduced absenteeism and utilization of employer-provided health benefits are common objectives. If the focus is more comprehensive, looking at the performance of the organization as a whole, a balanced score-card approach that includes employee health outcomes would be useful.

In terms of actions, even though the process of creating healthy workplaces is not well documented, we can identify common features. This is based on assessments of comprehensive workplace health promotion initiatives in various countries that attempt to address environmental conditions and individual health behaviours. In most instances, these did not jump to the next level — the healthy organization — because health outcomes and organizational results were not directly linked. But as a start, making that leap requires a clear understanding of these success factors.

Researchers have identified the following success factors in comprehensive workplace health promotion initiatives in a variety of organizations, economic sectors and geographic settings:

•a comprehensive approach, which addresses non-health issues as important health promoting factors;

•guided by an integrated, multidisciplinary team;

•a supportive corporate environment, which requires commitment from top management, reinforced by incentives and recognition for healthy behaviour;

•active involvement of employees and middle management through the process;

•job-level changes that increase employees’ sense of control and work autonomy;

•employee health promotion becomes embedded in regular management practices and business plans; and

•rigorous project management based on a needs analysis, a systematic and sequential approach to the problem, priority setting, a plan and continuous monitoring and evaluation.

Making the case for change

Thinking and action in the area of workplace health is in transition. The focus is shifting from programs designed to change individuals’ attitudes and behaviour to comprehensive interventions that target health risks in the physical, social and psychological work environment.

The most promising feature of the emerging healthy workplace perspective is the attempt to document the links between healthy work environments, on one hand, and improved health outcomes for individual employees and improved business results, on the other hand.

While we need a better understanding of exactly how healthy conditions in workplaces contribute to organizational performance, it is this link that offers the greatest potential to convince skeptical managers and business owners that investing in employee health and wellness is good business practice.

We may be on the verge of a breakthrough, because this widens the agenda to the entire organization and not just HR.

There is one major limitation, however. The healthy organization model nicely fits large organizations and their full-time employees. This leaves out one-third of the workforce — freelancers, contract and temporary workers, home-based workers, part-time workers, and own-account self-employed.

If employers want to set new levels of excellence in workplace health, they need to strive for an inclusive approach to the healthy organization. This can be achieved by embedding healthy workplace goals into a corporate social responsibility framework. Not only will this nurture healthy relationships with contractors, suppliers, temporary workers and customers, it also will contribute to building a healthy community.

Graham Lowe is president of The Graham Lowe Group Inc., a work consulting firm (www.grahamlowe.ca), and a professor of sociology at the University of Alberta. He can be reached at [email protected].

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