The Harvard School of Public Health Center for Work, Health and Wellbeing

Details

• Personal Author:
  Sorensen GC
• Description:
  The Center for Work, Health and Well-being at the Harvard T.H. Chan School of Public Health has played a leadership role in the development of the TWH approach since its inception. Critical findings from the Center during the 2016-2021 funding cycle have had a marked impact on the TWH® knowledge base and on reducing the burden of worker illness and injury. Center investigators created the defining conceptual model for TWH®, included in NIOSH's recent volume on Total Worker Health.® A conceptual model guides research by providing a map of priorities and key research questions. This model places a central focus on the conditions of work, including both physical, such as chemical and physical exposures, as well as organizational conditions of work such as an increasing pace of work and rising job instability, with consequences for psychological distress and increased risk of chronic disease. Following this conceptual model, Center investigators have conducted research to better understand the central role of working conditions as critical determinants of worker safety, health, and well-being. The Boston Hospital Worker Health Study, initiated at the start of the Center's funding in 2007, is a collaboration with Mass General Brigham (MGB, previously Partners Healthcare). Through this study, the Center established a database of approximately 22,000 hospital workers. This model employer database includes human resources data, injury incidence, worker compensation data, and healthcare utilization data matched with employee surveys. Using this dataset, the researchers have documented the relationships of an array of working conditions to workers' health, safety, and well-being, and to employer outcomes, including healthcare costs. These findings have also been used to inform policies and practices in the Mass General Brigham health care system, the largest employer in Massachusetts. A few examples illustrate the impact of this research. First, research about workplace mistreatment and worker injury and research about workplace bullying and mental health expenditures raised leaders' awareness of both prevalence of bullying and its worker health and enterprise consequences. Since the publication of those papers, reducing workplace bullying has become a major strategic priority for the health system. Second, the Center's research about low-wage workers and occupational health disparities has led to a broad and sustained commitment by Mass General Brigham leadership to reduce disparities and increase the applicability of employee health and well-being programs to low-wage workers. Third, the Center's research suggesting associations between working conditions and employee health expenditures has catalyzed greater integration between employee health promotion and occupational health departments within Mass General Brigham. That integration has, in turn, led to the creation of Total Worker Health-aligned policies and practices that the Center's research can analyze. Research within the Center has also tested the effectiveness of interventions to improve worker safety, health and well-being. During this funding period, the study, All the Right Moves for Subcontractors" developed and tested TWH® interventions in the construction industry, reaching over 12 employers and 600 workers. Starting with the Center's Implementation Guidelines and a focus on improving working conditions, this participatory intervention used the company's communication infrastructure, along with a needs assessment and report, committee-led prioritization, action planning and implementation, and a worker communication/feedback cycle. Although it was not possible to complete the intervention implementation in all study sites due to the COVID-19 shutdown, in the three companies where the program was successfully completed program, the study observed improvements in safety and health climate, improved worker participation, and higher TWHR implementation, compared to the companies without successful full implementation. With the COVID-19 shutdown, the study converted the intervention program to be implemented and sustained by company personnel, with a focus on COVID-19 related health and safety issues. This sustainable COVID-19 focused program was implemented with construction work crews of a local utility company and subcontractors on a worksite managed by a large national general contractor. The Center is disseminating the tools developed in this study in the renewal of the Center's work. The Center has also developed and tested measures of integrated TWHR approaches that advance the TWHR field. The Center's Workplace Integrated Safety and Health (WISH) Assessment measures workplace policies, programs, and practices that focus on working conditions and organizational facilitators of worker safety, health, and well-being. The tool can be used by employers and researchers to assess the extent of implementation of an integrated approach. This validated measure assesses six core constructs central to best practices for protecting and promoting worker safety, health, and well-being: (a) leadership commitment; (b) participation; (c) policies, programs, and practices that foster supportive working conditions; (d) comprehensive and collaborative strategies; (e) adherence to federal and state regulations and ethical norms; and (f) data-driven change. Available on the Center's website since 2018, the WISH tool has been downloaded more than 500 times. This measure was used in the Center's Enterprise Outcomes Study, developed in response to the exceptionally high risk of chronic disease and occupational injury among the 3.5 million workers in the U.S. nursing home industry. The central hypothesis was that nursing homes whose programs, policies, and practices align more closely with TWHR, as measured by our WISH Assessment, would have better outcomes with respect to occupational injury and quality of patient care compared to worksites less aligned with TWHR approaches. The study surveyed 570 nursing homes in California, Massachusetts, and Ohio using the WISH Assessment and assessments of the strength and types of their occupational health and wellness programs. The study merged these survey data with data on each facility's occupational injury rates, available through a partnership with Workers Compensation bureaus, and with data on quality of care (assessed as patient outcomes on key medical conditions) and nursing homes' operational, organizational, and patient characteristics, obtained from federally mandated administrative databases. Using this survey sample, we validated the WISH Assessment measure and used the survey data to abbreviate the tool. Ongoing analyses are evaluating (a) the relationship between TWHR as measured by the WISH Assessment and the numbers of COVID-19 cases among residents and staff at nursing homes; (b) the relationship of TWHR implementation to injuries; and (c) the relationships between TWHR implementation and nursing-sensitive quality indicators. The Center has disseminated and implemented best practices for TWHR interventions. The Center's Implementation Guidelines, developed in the prior funding cycle, defined our TWHR approach to improving conditions of work. The Guidelines have been downloaded from the Center's website more than 1500 times. The Guidelines are part of the Center's Capacity Building Suite, which also includes guidelines for training and technical assistance. The Center's work has demonstrated that this Capacity Building Suite can be used effectively by third-party providers to guide employers in the use of TWHR approaches. In addition, the Center has placed increasing priority on workplace and public policies as a critical facilitator of change, as evidenced by our publications, presentations at the TWHR international meetings. [Description provided by NIOSH]
• Subjects:
  Bullying Communicable Diseases Education Healthcare Disparities Health Personnel Health Promotion Mental Health Nervous System Occupational Health Safety Staff Development

  More +
• Keywords:
  COVID-19 Health Care Workers Health Disparities Health Promotion Mental Health Total Worker Health Training TWH Worker Safety Work Organization
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Final Cooperative Agreement Report
• Place as Subject:
  Massachusetts ; OSHA Region 1
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-44
• NIOSHTIC Number:
  nn:20065636
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U19-OH-008861, 2022 Mar; :1-44
• Contact Point Address:
  Glorian Sorensen, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue Boston, MA 02115- 6009
• Email:
  Glorian_sorensen@dfci.harvard.edu
• Federal Fiscal Year:
  2022
• NORA Priority Area:
  Healthcare and Social Assistance ; Construction
• Performing Organization:
  Harvard University, Boston, Massachusetts
• Peer Reviewed:
  False
• Start Date:
  20070901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20260831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:937fcc16535b25499117d15bdcecacfbf8df5f65cf5101a8a3e4dd6e283225d76f749684942374a7a27d12bfa0d553c4e20ce663b94bb9907d4d0b8eb993a009
• Download URL:
  https://stacks.cdc.gov/view/cdc/219116/cdc_219116_DS1.pdf
• File Type:
  [PDF - 1.44 MB ]