Introducing the total health framework

Taking an evidence-based approach to link health, engagement and productivity

Introducing the total health framework

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ARE you confident your  organiza­tion’s programs, policies and pro­cedures will net at least a three per cent improvement in employees’ health, engagement and produc­tivity over the next 12 months?

Now, imagine if your CEO or a board member or senior leader asked you the above question to­day — how comfortable would you be in giving an answer?

Current trends suggest a grow­ing percentage of the workforce is being negatively impacted by ha­rassment, mental health issues, work demands, job insecurity, turnover, financial stress and in­dustry change due to technology. Employers are challenged to not only retain employees but have them show up each day motivated and capable of doing their best.

The one profession best equipped to work with occupa­tional health and safety (OHS) to support human capital — and to put in place the structure that can answer questions like the above — is human resources.

For any HR professional to an­swer with a high degree of confi­dence they would, at a minimum, need the following:

  1. Understanding and acceptance of the direct link between employees’ health (meaning mental health, resiliency and psychological safety), engagement and productivity.
  2. Confidence in the value of making investments to influence employees’ health, engagement and productivity.
  3. Awareness of the specific ben­efits and impact a three per cent improvement could have on an organization’s financials.
  4. Commitment to continuous im­provement, using an evidence-based strategy that informs, monitors and measures pro­grams, policies and procedures’ impact on employees’ health, en­gagement and productivity.

This is the first in a 12-part se­ries on total health that will explore what we have learnt about the links between employees’ health, engagement and productivity. With a total health framework, organizations can get on track to answer these types of questions with a high degree of confidence.

The total health framework

The total health framework has adapted best practices from Canada’s Psychological Health and Safety in the Workplace standard, which provides principles and tools employers can use to facilitate an evidence-based continuous improvement program. Its goal is to eliminate employees’ risk for mental injuries and prevent work-related mental health issues.

The standard’s design is simi­lar to a traditional occupational health and safety management system. But it’s not meant to be a checklist or a one-and-done initiative — it’s meant to be an ongoing program that facilitates continuous plan-do-check-adjust (PDCA) cycles. When fully imple­mented, the standard provides a psychological health and safety management system that regu­larly checks for risks by ongoing measurements, internal audits and management reviews.

The total health framework is holistic in nature, as it contemplates four pillars of health: physical, mental, workplace and life (financial, relationships and work-life blending) with respect to how each can impact employees’ health, engagement and productivity.

Its design is similar to the stan­dard in that it’s evidence-based, with the goal of facilitating con­tinuous improvement using PDCA cycles. This framework is dynamic — an organization can start at any step in the process, as laid out in the accompanying graphic. It’s designed to be flex­ible to support implementing a psychological health and safety management system for solving a specific problem.

The framework’s five steps:

  1. Define the problem — The goal is to uncover current challenges and why these are of concern. This step can include a gap anal­ysis to understand root cause, define organizational readiness and maturity, understand lead­ership buy-in, and gain insights on available data. It can also build a business case that unpacks the cost of doing nothing.
  2. Investigate — This step’s goal is to obtain a baseline of work­place factors (such as bullying, manager-employee relationships and workload) that can positively or negatively impact employees’ health, engagement and pro­ductivity. It also discovers the average employee’s total health behavioural profile across each of the four pillars, using a total health assessment called Total Health Index.
  3. Develop strategy — This step reviews all available evi­dence-based data that supports problem-solving and informed decision-making. This frame­work promotes a two-way ac­countability model to achieve behavioural change, by defining key objectives and metrics. Once these are framed, it’s necessary to contemplate how to best engage employees and to communicate the model’s benefits, as well as how to implement new policies, procedures and programs.
  4. Design programs — This step is where programs are designed, implemented and measured. This process considers cultural factors, targeted populations, adult learning methodology, pro­gram evaluation and ROI targets. It also seeks to understand why employees engage, and why pro­grams work or fail.
  5. Determine value of invest­ment (VOI) — This step mea­sures the impact of programs, procedures and policies on em­ployee health, engagement and productivity. Depending on the total health strategy, it may in­clude internal audits, total health scorecards review, management reviews and VOI reports.

The total health five-step framework can help organizations resist the urge to automatically go from problem to programs. It enables them to put in place an evidence-based framework that promotes sustainability and con­tinuous improvement.

Organizations looking to adopt best practices from the standard and implement a psychological health and safety management system can build on the total health framework.

When it comes to retaining a highly engaged and healthy work­force, the benefits and risks can be  high. It’s much more effective to use an evidence-based approach versus a hope-and-pray method.

When implemented, the total health framework gives HR pro­fessionals the confidence that they are on track to reach targeted outcomes (such as a three per cent improvement) in the coming year.

To learn more on the total health framework, please go to

Bill Howatt, Ph.D. Ed.D., is the chief of research and development, workforce productivity, at Morneau Shepell in Toronto. For information on the na­tional psychological standard, visit For information on PDCA cycles, see


This is the first of a 12- part series on total health that will explore the links between employees’ health, engagement and productivity:

  1. The total health framework
  2. Four pillars of the total health index
  3. Canada’s total health index
  4. Resiliency
  5. Alcohol
  6. A respectful workplace
  7. Manager effectiveness
  8. Financial health
  9. Going beyond traditional engagement
  10. Productivity
  11. Mental health
  12. Physical activity, nutrition, sleep

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