68: Why You Should Care About Total Worker Health (TWH) & Safety

Jul 19, 2019

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Fundamentals of Total Worker Health 

Keeping workers safe is the foundation upon which a TWH approach is built. Total Worker Health integrates health protection efforts with a broad spectrum of interventions to improve worker health and well-being.

The Fundamentals of Total Worker Health Approaches is the practical starting point for employers, workers, labor representatives, and other professionals interested in implementing workplace safety and health programs aligned with the Total Worker Health (TWH) approach. There are five Defining Elements of TWH:

Element 1: Demonstrate leadership commitment to worker safety and health at all levels of the organization.

Element 2: Design work to eliminate or reduce safety and health hazards and promote worker well-being.

Element 3: Promote and support worker engagement throughout program design and implementation.

Element 4: Ensure the confidentiality and privacy of workers.

Element 5: Integrate relevant systems to advance worker well-being.

Getting Started

Create a team of people who know about different policies, programs, and practices in your workplace that impact worker safety, health, and well-being. Draw team members from all levels of the workforce, and consider including the following:„

  • workers who have requested or participated in changes for safety and health „„safety directors
  • „„human resources representatives
  • „„occupational health nurses or other healthcare practitioners
  • „„workers’ compensation professionals
  • „„Employee Assistance Program professionals
  • „„staff responsible for disability management and return-to-work procedures „„health and wellness champions.

Defining Element 1: Demonstrate leadership commitment to worker safety and health at all levels of the organization

Organizational leaders should acknowledge and communicate the value of workforce safety and health as a core function, and they should prioritize worker safety and health on the same level as the quality of services and products.

ProTip: Middle management is the direct link between workers and upper management and plays a critical role in program success or failure. For example, supervisors often serve as gatekeepers to employee participation in programs, and when program involvement competes with productivity demands, they may discourage employee participation

Effective programs thrive in organizations that promote respect throughout the organization and encourage active worker participation, input, and involvement. Leaders at all levels of the organization can help set this tone, but everyone (from managers down to front-line workers) plays an essential role in contributing to this shared commitment to safety and health. Beyond written policies, stated practices, and implemented programs that endorse safety and health in your workplace, consider the extent to which your organization’s spoken and unspoken beliefs and values either support or deter worker well-being [CPWR and NIOSH 2013].

Encourage top leaders to:

  • Establish and communicate the principles of the proposed initiative to all levels of the organization; teach managers to value workers’ input on safety and health issues.
  • „„Maintain the visibility of the effort at the organization’s highest levels by presenting data that is linked to the program’s resource allocations. Promote routine communications between leadership and employees on issues related to safety, health, and well-being.
  • „„Openly support and participate in workplace safety and health initiatives. „„Facilitate participation across all levels of the workforce.
  • „„Add safety and health-related standards into performance evaluations. „„Build safety and health into the organization’s mission and objectives. „„Establish a mechanism and budget for acting on workforce recommendations. „„Emphasize that shortcuts must not compromise worker safety and health.
  • „„Provide adequate resources, including appropriately trained and motivated staff or vendors, space, and time. If necessary, ensure dedicated funding over multiple years, as an investment in your workforce.

Encourage mid-level management to:

  • Recognize and discuss the competitive advantage (e.g., recruitment, retention, employee satisfaction, community engagement and reputation, and workforce sustainability) that TWH brings to the long-term sustainability of the organization.
  • „„Highlight examples of senior leadership’s commitment to TWH.
  • „„Provide training on how managers can implement and support Total Worker Health–aligned approaches, such as those related to work-life balance.

Defining Element 2: Design work to eliminate or reduce safety and health hazards and promote worker well-being

A Total Worker Health approach prioritizes a hazard-free work environment for all workers. It applies a prevention approach that is consistent with traditional occupational safety and health prevention principles of the Hierarchy of Controls.

Eliminating or reducing recognized hazards in the workplace first, including those related to the organization of work itself, is the most effective means of prevention and thus is foundational to all Total Worker Health principles. Although some hazards can be eliminated from the work environment, others (such as shift work) are more difficult to change. These must be managed through various engineering, administrative, or (as the very last resort) individual-level changes. Workplace programs that adopt a TWH approach emphasize elimination or control of workplace hazards and other contributors to inadequate safety, health, and well-being. This emphasis on addressing environmental determinants of health is a crucial concept for TWH programs.

The Hierarchy of Controls Applied to NIOSH Total Worker Health® provides a conceptual model for prioritizing efforts to advance worker safety, health, and well-being. This applied model is based on the traditional Hierarchy of Controls well-known to occupational safety and health professionals.

As in the traditional Hierarchy of Controls, controls, and strategies are presented in descending order of anticipated effectiveness and protectiveness, as suggested by the cascading arrows. The Hierarchy of Controls Applied to NIOSH Total Worker Health expands the traditional hierarchy from occupational safety and health to include controls and strategies that more broadly advance worker well-being.

The Hierarchy of Controls Applied to NIOSH Total Worker Health is not meant to replace the traditional Hierarchy of Controls, but rather is a companion to this important occupational safety and health model. It serves to illustrate how TWH approaches emphasize organizational-level interventions to protect workers’ safety, health, and well-being. To apply this model:

  • Begin by eliminating workplace conditions that cause or contribute to worker illness and injury or otherwise negatively impact well-being. These include factors related to supervision throughout the management chain.
  • Second, replace unsafe, unhealthy working conditions or practices with safer, health-enhancing policies, programs, and management practices that improve the culture of safety and health in the workplace.
  • Next, redesign the work environment, where needed, for safety, health, and well-being. Remove impediments to well-being, enhance employer-sponsored benefits, and provide flexible work schedules.
  • Then, provide safety and health education and resources to enhance personal knowledge for all workers.
  • Lastly, encourage personal change for improvements to health, safety, and well-being. Assist workers with individual risks and challenges; provide support for healthier choice-making.


Using the Hierarchy of Controls Applied to NIOSH Total Worker Health, a program targeting reductions in musculoskeletal disorders could consist of the following:

  1. Reorganizing or redesigning the work to minimize repetitive movement, excessive force, and awkward postures
  2. Providing ergonomic consultations to workers to improve job and workstation design and interface, along with training in ergonomic principles and opportunities for workers to participate in design efforts
  3. Evaluating the age profile and health needs of the workforce to provide education on self-management strategies (including preventive exercise) for arthritis or other musculoskeletal conditions that impact the physical ability

Similarly, a TWH program reducing work-related stress might consider the following:

  1. Implementing organizational and management policies that give workers more flexibility and control over their work and schedules, as well as opportunities to identify and eliminate root causes of stress
  2. Providing training for supervisors on approaches to address stressful working conditions
  3. Providing skill-building interventions for stress reduction for all workers and providing access to the Employee Assistance Program

Defining Element 3: Promote and support worker engagement throughout program design and implementation

Ensure that workers involved in daily operations, as well as supervisory staff, are engaged in identifying safety and health issues, contributing to program design, and participating in all aspects of program implementation and evaluation. Again, letting workers be involved in workplace safety, health, and well-being, instead of being just recipients of services, nurtures a shared commitment to Total Worker Health. Some ways to do this include:

  • „„Identify safety and health issues that are most important to front-line employees
  • „„More effectively identify potential barriers to program use and effectiveness
  • „„Improve the long-term sustainability of initiatives
  • „„Increase employee buy-in and participation in policies and other interventions.

ProTip: Design programs with a long-term outlook to ensure sustainability. Short-term approaches have short-term value. Programs aligned with the core values of the organization will likely last. These should be flexible enough to be responsive to changes in workforce and market conditions, workplace hazards and exposures, and the needs of individual workers. A participatory approach can help in this regard, but keep sustainability in mind for the bigger picture.

To help encourage worker engagement, communicate strategically; everyone with a stake in worker safety and health (workers, their families, supervisors, etc.) must know what you are doing and why. Tailor your messages and how they are delivered, and make sure they consistently reflect the values and direction of the initiative.

Whether workers are willing to engage in workplace safety and health initiatives, however, may depend on their perceptions of whether the work environment truly supports safety and health. For example, one study found that blue-collar workers who smoke are more likely to quit and stay quit after a worksite tobacco cessation program if workplace dust, fumes, and vapors are controlled and workplace smoking policies are in place

Defining Element 4: Ensure the confidentiality and privacy of workers

Designing and enforcing appropriate privacy protections goes beyond ensuring that only authorized personnel has access to sensitive safety and health information. Observe all relevant local, state, and national laws regarding the privacy of personally identifiable data and health-related information by taking appropriate steps. So doing things like masking personally identifiable information on reports, and using a digital management system that is encrypted and protected by user passwords are some best practices.

Data sources that require confidentiality considerations and/or protections:

  • „„Health risk assessments
  • „„Electronic health records
  • „„Management systems
  • „„Program evaluation data
  • „„Self-reported survey data

Privacy precautions:

  • „„Rigorous de-identification of records
  • Destruction of personally identifiable information as appropriate
  • Hiring a third party to handle certain aspects of the program to reduce employee fear of retribution or penalty
  • „„Using group or population-level data rather than individual data

 Defining Element 5: Integrate relevant systems to advance worker well-being.

Total Worker Health emphasizes the role that organizations have in shaping worker safety and health outcomes, recognizing that a multilevel perspective that includes policy, environmental, organizational, and social concerns may be best for tackling complex challenges to worker safety, health, and well-being. Integrating data systems across programs and among vendors, for instance, can simplify monitoring and evaluation while also enabling both tracking of results and continual program improvement.

Consider ways to integrate relevant systems within your organization:

  1. Conduct an initial assessment of existing workplace policies, programs, and practices pertinent to safety, health, and well-being and determine how they relate to one another. Note: for some larger organizations, this may seem like an overwhelming task. To assist in helping to focus this step, consider, at a minimum, these factors:„„ Human resources or personnel policies on issues such as health insurance, paid sick leave, family leave, vacation benefits, retirement, and disability. „„Safety and health policies and procedures for identifying hazards, reporting work-related injuries and illnesses, and filing workers’ compensation claims. 
  2. Identify apparent areas of overlap with existing efforts, and note opportunities for future coordination.
  3. Purposefully and regularly bring together leaders and teams with overlapping or complementary responsibilities for planning and priority setting. For example, hold joint meetings of safety committees and occupational health staff, human resources, and wellness committees.

 Questions to Consider Asking Yourself or Your Team

  • Do we regularly seek the input of our workers on the selection and design of our offered benefits?
  • How can we change or adjust management policies or programs to more effectively support improved safety and health?
  • „„How does the everyday physical work environment affect workers’ safety and health?
  • Beyond our workplace policies or programs that may be targeting safety and health, what influence do our workplace or organizational norms have on worker safety and health outcomes?
  • How do our efforts feed into the community at large? What sorts of resources outside the workplace, such as community support, would be useful in helping to reinforce and support our safety and health programs?

Understanding the connections between various systems and levels of an individual worker’s experience may help design creative, well-rounded approaches to safety and health challenges.

By working together and discovering what each professional in the organization is already working on you will often find related goals and objectives – the benefits administrator struggling to get workers to participate in an exercise class and the safety professional struggling to get a warm-up/stretching program started will be able to work together. So to put a pin in this topic, I will say this: If you want to have a successful wellness program, you must first have a strong culture of workplace safety. Then you can build on that credibility and ask folks to move toward participating in safety or health-related activities off-the-job. Make sure you are first building a workplace safety culture.

Let me know what you think about this episode. Send emails to info@thesafetypropodcast.com and share with me your thoughts.

You can find me on LinkedIn! Post an update, letting me know what you think of the podcast. Be sure to @ mention Blaine J. Hoffmann or The SafetyPro Podcast LinkedIn page. You can also find the podcast on FacebookInstagram, and Twitter

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