Healthier Supervision

L. Casey Chosewood, MD MPH

Chia-Chia Chang, MPH, MBA

NIOSH Office for Total Worker Health

A TOTAL WORKER HEALTH® Workshopfor the VALLEY HEALTH ALLIANCE

May 5, 2016Pitkin County Health and Human Services

The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health, and should not be construed to represent any agency determination or policy.

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• Introductions and Icebreaker

• Total Worker Health®: Why is it More Important than Ever?

• Characteristics & Benefits of Healthier Supervision

• Healthier Supervision and Total Worker Health

• Tools for Healthier Supervision

• Group Activity

• Resources

• Wrap Up

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Healthier Supervision

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http://www.ilo.org/global/about-the-ilo/decent-work-agenda/lang--en/index.htm

“Work is central to people's well-being.”

“Decent work sums up the aspirations of people in

their working lives.”

--International Labour Organization (ILO)

Decent Work

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“Well-Being”?

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6Underwriters Laboratories (UL). State Reports on Health Determinants and Workplace Safety Conditions, 2016.

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Underwriters Laboratories (UL) , State Reports on Health Determinants and Workplace Safety Conditions., 2016.

• Little job security• Minimal advancement• Hazardous work• Health insurance• Responsibility• Representation• Vulnerable populations

Changing Employment PatternsPrecarious work, dual employers, etc

“My father had one job in his life,

I’ve had six in mine,

my kids will have

six at the same time”

“The future of work: Five ways work will change in the tuture,”

The Guardian, Nov 29, 2015

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Shift working men:Less likely to eat vegetables & fruits

Shift working women:More energy intake from saturated fat

Hemiö K, et. al. Food and nutrient intake among workers with different shift systems. Occup Environ Med 2015; 0: 1–8

Low-Wage Workers

• Increased risk of job stress— Decisional latitude,

control, respect• Job insecurity• Forced overtime• Discrimination

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Winston, P. Office of Human Services Policy/ASPE, U.S. Dept. of Health and Human Services. Work-family supports for lower income families: Key research findings and policy trends. January 19, 2016 NIOSH Total Worker Health® Webinar

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Policies, programs, and practices that integrate Protection from work-related safety and health hazardswith promotion ofInjury and illness prevention efforts to advance Worker well-being

Total Worker Health®

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November 2015

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American Heart Association News March 1, 2016, http://news.heart.org/study-older-workers-in-sales-have-great-heart-risks/

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Example of Integrated ApproachMusculoskeletal Disease

Reorganizing

workErgonomic

consultations

Arthritis self-management

strategies

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Increase Program Participation and Effectiveness

Integrated interventions

Single intervention

Smoking quit rates:

11.8%

5.9%Sorensen G and Barbeau E. Integrating Occupational Health and Safety and Worksite Health Promotion: State of the Science. The NIOSH Total Worker HealthTM Program: Seminal Research Papers 2012. DHHS (NIOSH) 2012-146.

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Reduced Sickness Absence & Improved Health

Reduced:• Ergonomic risks• Cardiovascular risks • Job stressors

Reciprocal improved outcomes such as morale, engagement, and employee retention

Sorensen G and Barbeau E. Integrating Occupational Health and Safety and Worksite Health Promotion: State of the Science. The NIOSH Total Worker HealthTM Program: Seminal Research Papers 2012. DHHS (NIOSH) 2012-146.

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Obesity: Improving the Job

Punnett L and the Center for the Promotion of Health in the New England Workplace. Recent trends and research in worker safety and health. February 25, 2014 NIOSH Total Worker Health® Webinar

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Du J and Leigh JP. Effects of wages on smoking decisions of current and past smokers. Annals of Epidemiology 2015; 25: 575-582

Smoking: Improving the Job

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Stress: Improving the Job

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Goh, J., Pfe!er, J., & Zenios, S. A. Workplace stressors & health outcomes: Health policy for the workplace. Behavioral Science & Policy, 1(1), 2015, pp. 43–52. https://behavioralpolicy.org/article/workplace-stressors-health-outcomes/

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Before Work

After Work

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Workplace Flexibility

1/3 turnover rate

Reduced turnover.Customer retention 96% $6 million 2 years

17% Increased productivity

Office of Disability Employment Policy. Workplace flexibility: A strategic business approach for an inclusive workplace. http://www.dol.gov/odep/pdf/workplaceflexibility.pdf

Issues Relevant to Advancing Worker Well-being Through Total Worker Health

®

Control of Hazards and Exposures• Chemicals• Physical Agents• Biological Agents• Psychosocial Factors • Human Factors• Risk Assessment and Risk Management

Organization of Work• Fatigue and Stress Prevention• Work Intensification Prevention• Safe Staffing• Overtime Management• Healthier Shift Work• Reduction of Risks from Long Work Hours• Flexible Work Arrangements• Adequate Meal and Rest Breaks

Built Environment Supports• Healthy Air Quality• Access to Healthy, Affordable Food Options• Safe and Clean Restroom Facilities• Safe, Clean and Equipped Eating Facilities• Safe Access to the Workplace • Environments Designed to Accommodate

Worker Diversity

Leadership• Shared Commitment to Safety, Health,

and Well-Being• Supportive Managers, Supervisors,

and Executives• Responsible Business Decision-Making• Meaningful Work and Engagement• Worker Recognition and Respect

Compensation and Benefits • Adequate Wages and Prevention of

Wage Theft• Equitable Performance Appraisals

and Promotion • Work-Life Programs• Paid Time Off (Sick, Vacation, Caregiving)• Disability Insurance (Short- & Long-Term)• Workers’ Compensation Benefits• Affordable, Comprehensive Healthcare

and Life Insurance• Prevention of Cost Shifting between

Payers (Workers’ Compensation, Health Insurance)

• Retirement Planning and Benefits• Chronic Disease Prevention and

Disease Management• Access to Confidential, Quality

Healthcare Services• Career and Skills Development

Community Supports• Healthy Community Design• Safe, Healthy and Affordable Housing

Options• Safe and Clean Environment (Air and Water

Quality, Noise Levels, Tobacco-Free Policies)

• Access to Safe Green Spaces and Non-Motorized Pathways

• Access to Affordable, Quality Healthcare and Well-Being Resources

Changing Workforce Demographics• Multigenerational and Diverse Workforce• Aging Workforce and Older Workers• Vulnerable Worker Populations• Workers with Disabilities• Occupational Health Disparities• Increasing Number of Small Employers• Global and Multinational Workforce

Policy Issues• Health Information Privacy• Reasonable Accommodations• Return-to-Work• Equal Employment Opportunity• Family and Medical Leave• Elimination of Bullying, Violence,

Harassment, and Discrimination• Prevention of Stressful Job

Monitoring Practices• Worker-Centered Organizational Policies• Promoting Productive Aging

New Employment Patterns• Contracting and Subcontracting• Precarious and Contingent Employment• Multi-Employer Worksites• Organizational Restructuring, Downsizing

and Mergers• Financial and Job Security

November 2015Total Worker Health® is a registered trademark of the US Department of Health and Human Services 25

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

Safety comes first

2. Integrate relevant systems to advance worker well-being

Privacy protection

3. Demonstrate leadership at all levels of managementLong-term culture-building

4. Promote and support worker engagement throughout program design and implementation

Equal access to all employeesVoluntary

Fundamentals of Total Worker Health

IMPLEMENTING TOTAL WORKER HEALTHTHROUGH

HEALTHIER SUPERVISION

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CHARACTERISTICS & BENEFITS OF HEALTHIER SUPERVISION

• BE THE SUPERVISOR YOU WOULD WANT TO HAVE

• MEANINGFUL WORK AND ENGAGEMENT

• LEAD OR MANAGE

• ENHANCE YOUR OWN LEADERSHIP & MANAGEMENT SKILLS

• INTERACTING WITH YOUR TEAM

• DESIGN METHODOLOGY

• BENEFITS OF HEALTHIER SUPERVISION

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Characteristics of Meaningful Work

http://web.hec.ca/criteos/fichiers/upload/MOW_in_MTimes_EMM200804.pdf

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Employee EngagementJust how engaged are American workers?

• What is engagement?

• 2014 Gallup Wellbeing Survey– 31.5% employees engaged– 51.0% not engaged– 17.5% actively disengaged

• 2016 Gallup Wellbeing Survey– 34.1% employees engaged– Sets new record since polling began in 2011– Previous high was in March 2011 at 33.8%

Source: 2014 and 2016 Data Gallup Survey on Employee Engagement www.gallup.com

Increasing Engagement

• Whose job is it?

• Strategies

• Active vs. Passive

• What level of management is accountable for this?

• What metrics can we use to follow it?

LEAD or MANAGE?

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Leadership vs. Management

Accomplishes a GoalExplains the VisionMotivates Others

Mobilizes ResourcesCommunicates Well

Source: http://changingminds.org/disciplines/leadership/articles/manager_leader.htm

Vision & StrategyCreating ValueInfluence and InspirationHas FollowersCharismaticPeople FocusedProactive Risk & Change SeekersSets directionRaises expectationsAsks questions

Policies & ProceduresCounting Value

Power & ControlHas Subordinates

Manages WorkWork Focused

Authoritarian StyleReactive

Risk Averse & StabilityPlans Details

Maintains Status QuoGives Directions

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Enhance Your Own Leadership and Management Skillset

• Get to know yourself better– 360° profiles, DISC, personality instruments

• Actively communicate – The power of “Good Morning”

• Work on transparency• Recognize and reward every day• Set clear expectations and reset regularly

How do you interact with your team?

• “Management by walking around”

• Keeping it professional

• Getting personal

• Exit interviews

• Stay interviews

• Who’s at “flight risk” on your team?

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Solving Problems Using Design Methodology

• Empathize: seek to understand the perspective of the person(s) experiencing the problem

• Define: mutually reach consensus on the nature of the problem

• Ideate: openly brainstorm wide set of possible solutions

• Prototype: pick the most promising solution for a “rough trial”

• Test: try out the solution and evaluate outcome

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https://www.advisory.com/talent-development/employee-engagement-initiative/members/expert-insights/2011/how-important-is-having-an-effective-manager

Benefits of Healthier Supervision

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http://www.monster.com/about/a/dangerously-stressful-work-environments-force-workers-to-seek-new-empl4162014-d3126696

The most commonly reported workplace stressors include: Supervisor relationship (40%) Amount of work (39%) Work-life balance (34%) Coworker relationships (31%)

“What does your office do to help alleviate stress in the workplace?” 13%: Extra time-off11%: Ability to work from home66%: Nothing

Importance of Healthier Supervision

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Wrike. Work Management Report 2015. https://www.wrike.com/blog/2015-work-management-survey-report

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http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2016-04-22-transformational-managers-may-be-bad-for-workplace-health-/Karina Nielsen & Kevin Daniels (2016) The relationship between transformational leadership and follower sickness absence: the role of presenteeism, Work & Stress, 30:2, 193-208

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Dow Scott and Tom McMullen. The Impact of Rewards Programs on Employee Engagement. WorldatWork. June 2010. https://www.worldatwork.org/waw/adimLink?id=39032

Quality of leadership had the strongest relationship with effectively engaging and motivating employees.

BREAK

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HEALTHIER SUPERVISION AND TOTAL WORKER HEALTH

• CREATING THE RIGHT ENVIRONMENT FOR YOUR DIVERSE WORKFORCE

• INTEGRATING WORK AND LIFE CHALLENGES

• ALTERNATIVE WORK ENVIRONMENTS

• BENEFITS OF WORK-LIFE INTEGRATION

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“Timing is Everything”

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Many More Older Workers

“Chronologically Gifted”

“Age to me means nothing. I can't get old; I'm working. I was old when I was twenty-one and out of work. As long as you're working, you stay young."

— George Burns (1896-1996)

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The National Center for Productive Aging and Work (NCPAW)

Jim Grosch & Juliann Scholl

Co-Directors

• Manage physical hazards, e.g., noise, slips/trips

• Provide ergonomically-friendly work environments

• Provide aging workforce management skills training for supervisors

• Invest in training & skill-building for all workers• Encourage cross-generational interactions

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Improving the JobTo Be Age Friendly

• Accommodate medical self-care

• Support return-to-work

• Design jobs with worker involvement Match tasks to abilities, function Offer flexibility: Self-paced,

scheduling, transitional

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Improving the JobTo Be Age Friendly

5. Partnership for Solutions [2004]. Chronic conditions: making the case for ongoing care. Baltimore, MD: Partnership for Solutions. [http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf].

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Invisible Illness

• Approximately 96% of people who live with a health concern have what is known as an “invisible illness”.

• These people do no use a cane or any assistive device and may look perfectly healthy.

58SOURCE: 2002 US Census Bureau

Common Invisible Illnesses • ADHD

• Anxiety disorders

• Allergies

• Asthma

• Autism

• Bipolar disorder

• Brain injuries

• Chronic fatigue syndrome

• Chronic pain

• Circadian rhythm sleep disorders

• Personality disorders

• Primary immunodeficiency

• Reflex Sympathetic Dystrophy

• Rheumatoid arthritis

• Schizophrenia

• Scleroderma

• Sjogren's syndrome

• Transverse Myelitis

• Ulcerative Colitis

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• Celiac Disease

• Crohn's disease

• Depression

• Diabetes

• Endometriosis

• Epilepsy

• Fibromyalgia

• Food allergies

• Hyperhidrosis

• Inflammatory bowel disease

• Interstitial cystitis

• Irritable Bowel Syndrome

• Lactose Intolerance

• Lupus

• Lyme Disease

• Migraines

• Multiple Sclerosis

• Multiple Chemical Sensitivity

• Myasthenia Gravis

• Narcolepsy

Managing Culture in the WorkplaceCognitive Diversity

• A blend of different backgrounds, experiences and perspectives within a team

• Capitalize on unique skillsets to fill knowledge gaps

• Encourage innovation and creativity

http://www.goodwill.org/blog/career-and-financial-advice/eight-ways-to-pitch-your-diverse-background-as-an-employment-asset/

Managing Culture in the WorkplaceCultural Challenges

• “The sum total of ways of living built up by a group of human beings and transmitted from one generation to another” (Websters)

• Leadership Challenges:– Minority recruitment & retention – Managing perceptions– How do you foster diversity and culture?

• A diversity conscious culture is more likely to recruit, attract, and retain talent.

• A diverse workforce serves customers and partners in a more meaningful way.

Source: http://thediversitycoach.com/managing-culture-diversity-in-the-modern-workplace/

Dr. Howard chats with others at the 2015 Cincinnati Meet and Greet NIOSH Diversity Steering Council 2010-2013

Diversity Month across NIOSH

Spokane, Washington: “Back to Our Roots” potluck

Denver, Colorado:Volunteers donating blood for

the “Gift of Life”

Atlanta, Georgia: “Diversity in Food & Activity”:

Line dances after a communal salad bar lunch

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Managing Culture in the WorkplacePerception & Reality

• Change is hard when it comes to shaping culture– Identifying what the culture is and how it can be improved

• Viewpoint Surveys, Focus Groups, Staff Meetings, Open Door Policy

– Implementing a coordinated ongoing effort– Making a personal commitment

• Effective culture management requires everyone to be on the same page, both in the spoken and unspoken policies and behaviors

Diversity Efforts Can Enhance Employee Engagement

• Utilize conflict and diversity as an asset, not a liability

• Managing diversity:– The basic concept of managing diversity accepts that the

workforce consists of a diverse population of people. The diversity consists of visible and non-visible differences, some of which include: gender, ethnicity, educational level, family of origin, disability, sexuality, age and religion.

Benefits of Implementing Work-Life Integration

• Improves health and well-being of employees (and benefits family members also)

• Less stress on employees leads to increased productivity

• Flexibility and supervisor support is key to overall job satisfaction and employee engagement

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Integrating Work and LifeChallenges

• Work-Life interface is a concern of ALL workers.• Work – life conflict is prevalent.

– Nearly 60% of workers experience conflict– At least 20% reporting they often/always are in conflict.

• Demands on families are increasing - which affects wellbeing in all spheres of life.– Work can be modified to improve balance and support

well-being using alternative work schedules.– Increasing supervisory flexibility is often highly effective

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STAR Study Results

• Increased– Control over work time– Supervisor support for personal and family life– Saying have "enough time" with family

• Decreased– Work-to-family conflict– Family-to-work conflict

• No effect on work hours, intensity overall– Parents' work hours declined - 1 hr/week

• Decreased burnout, stress, psychological distress at 12 months, though only among respondents who started STAR before merger underway

SOURCE: Kelly, Moen et al. 2014. American Sociological Review.68

Alternative Work Environments• Possible? Impossible? Uncomfortable?• Value of telework and flexi-time• Setting clear expectations with your staff• Fairness

– Actual & Perceived– Avoidance of “all or none” policies or blanket

approaches

• Reasonable Accommodations

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TOOLS FOR HEALTHIER SUPERVISION

• PERFORMANCE MANAGEMENT

• HELPING UNDER-PERFORMERS

• EMPLOYER & EMPLOYEE RECOGNITION

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Performance ManagementUtilize Performance Plans to Gauge Potential

• Individually-based plans are intended to stretch your employees, to develop potential, and grow opportunities– Use SMART goals (specific, measurable, aligned, realistic, timely)

– NOT generalized to series or position type

– Encourage employee’s input

– Should align with duties listed on position description

– Become familiar with local union/bargaining unit requirements

Performance ManagementUtilize Performance Plans to Gauge Potential

• Be aware of knowledge gaps – Use performance discussions to discuss areas for

growth and improvement

– Utilize individual development plans to encourage learning and gaining new skills

Performance ManagementSeek Solutions

• Job Rotations

• Continuing Education

• Mini-Internships or Fellowships

• Mentoring Program

• Coach-Approach

• “Stay” Interviews

Helping Under-Performers

WON’T Employees (Conduct Problems)Do not obey written/unwritten rules

Deliberate

Some conduct problems can appear as performance problems

CAN’T Employees (Performance Problems)Do not meet expectations of the quality, volume, and speed of the work

Origin can be multifaceted

Combination

Helping Under-PerformersLook for the Cause

Make sure the cause of the problem is not management or an organizational or procedural problem.

Ensure the employee has been adequately instructed on how to perform the job and given the right feedback.

Determine if there are external obstacles preventing acceptable performance (medical condition, substance abuse, life-family conflict)

Take a hard look at whether or not the employee has the specific skills, knowledge, or ability to perform in the position.

Helping Under-PerformersProvide Resources for Improvement

Additional job aids (e.g., desk guide, manual references, examples of acceptable work products)

Closer supervision or an on-the-job coach

Referral to the Employee Assistance Program (EAP) for substance abuse or other personal problems

Reassignment

Job restructuring

Helping Under-Performers

Don’t go it alone. Get help early.Focus the employee’s attention on the problem.

Informal measuresFormal counselingFormal performance improvement plan/period (PIP). This provides information about exactly what he or she is doing wrong and what they must do to keep the job.

Take a performance-based action.If the PIP does not cure the problem, close out with a removal, demotion or a reassignment. Always consult with your servicing Employee Relations Specialist.

Engagement Challenges: Addressing the “Difficult” Worker

• First ask: Am I being the “difficult” one?• The value of asking why?• Avoiding management by neglect• Examine expectations

– Demands of job vs. resources available

• Job fit, training, reassignment• Engagement, meaningful work• Getting help; use available resources

– Other leadership– EAP– Employee relations

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Special Considerations

• Workers with disabilities– Apparent– Hidden/invisible– Privacy issues– Reasonable Accommodations

• Impaired workers• Aging workers• Working parents/caregivers

– Sandwich generation

• Recognizing Red Flags

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Employee RecognitionDo it early and often but learn your employees’ preferences

Public vs. private praiseAcknowledging staff at All Hands or team meetingsMore subtle acknowledgements for “introverts”Letters from the Division Director or other senior leader

New opportunities, promotions, trainings, details and similar interventions can reward and recognize

A promotion is not always a financial increase or a new positionFor an eager worker, it may be additional duties, new responsibilities, or a chance to be on a workgroup or make a presentation

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Employee Recognition

• Certificate of Appreciation

• Service Awards

• Monetary awards

• On-the-spot Awards

• Time-off Awards

• Suggestion Awards

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Enhance Employee Engagement

• Increase social interactions among staff– Utilize cross-training and

workgroups as a relationship builder amongst your staff

– Cross-generational efforts

– Use work and non-work anchors for connecting individuals Bike to Work Day

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Summary: Enhance Your Leadership and Management Skillset

• Get to know yourself better• Actively communicate • Work on transparency• Set clear expectations and be willing to reset when needed• Intervene early when performance or conduct issues arise• Recognize and reward your team every day• Attend to work-life-family issues: your own and your team’s• Learn new things. Enhance your own leadership skills regularly• Get help when you need it

BREAK

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GROUP ACTIVITY

DESIGNING AN INTEGRATED APPROACH TO ADDRESS SAFETY AND HEALTH ISSUES

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Group Activity Instructions1. Break into groups and identify representatives

2. Choose a real-life setting

3. Identify a safety, health, and/or well-being issue

4. Discuss key organizational factors

5. Choose 1-2 interventions that could improve the issue

6. Plan the first steps of your intervention

7. Report back to larger group at 11:15

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TWH & CDC RESOURCES

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http://www.cdc.gov/niosh/twh/totalhealth.html

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Simple Steps to Get Startedhttp://www.cdc.gov/niosh/twh/steps.html

[3/22/2016 9:09 AM] Chang, Chia-Chia (CDC/NIOSH/OD):

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National Aeronautics and Space Administration

University of Colorado Center for Worker Health and Environment

Dartmouth-Hitchcock Medical Center

Kentucky Department for Public Health

Mount Sinai Health System

Kentucky Injury Prevention and Research Center

National Safety Council

Nebraska Safety Council

University of Michigan

International Brotherhood of Boilermakers

SAIF Workers Compensation

University of North Carolina

University of Georgia

Laborers’ Health and Safety Fund of North America

Western Kentucky University

Oregon Healthy WorkForce Center

University of Iowa Healthier Workforce

Center for Excellence

Center for the Promotion of Health in the New England

Workplace

Harvard T.H. Chan School of Public Health

Center for Work, Health, and Well-being

Centers of Excellence and TWH AffiliatesISSA -The Worldwide Cleaning Industry Association

Labor Occupational Health Program, University of California Berkeley School of Public Health

American Association of Occupational Health Nurses

Northern Kentucky University

Valley Health Alliance

American College of Preventive Medicine

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Assessment Toolshttp://www.cdc.gov/niosh/twh/tools.html

1. Integration of Health Protection and Health Promotion: Rationale, Indicators, and Metrics (Sorensen et al, 2013)

2. CDC Worksite Health ScoreCard (HSC)

3. NIOSH Organization of Work Measurement Tools for Research and Practice

4. NIOSH Quality of Worklife Questionnaire

5. Occupational Safety and Health Administration (OSHA) Form 33

6. American College of Occupational and Environmental Medicine’s Corporate Health Achievement Award

7. CDC Workplace Health Assessment

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Guidelines for Integrated Approacheshttp://www.cdc.gov/niosh/twh/tools.html

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Topic-specific resources of interest

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http://www.cdc.gov/sixeighteen/

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http://www.uspreventiveservicestaskforce.org/

Free continuing education credits

http://www.cdc.gov/niosh/twh/webinar.html

Next webinar: September 2016

Slated topic: Productive Aging: Strategies for Developing Age-Friendly Workplaces

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Ways to Connect with Total Worker Health®

Twitter(@NIOSH_TWH)

LinkedIn Group

(Search “NIOSH Total Worker Health”)

TWH in Action! e-Newsletter

http://www.cdc.gov/niosh/TWH/newsletter/

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Contact

Email: TWH@cdc.gov

NIOSH Total Worker Health® website:

http://www.cdc.gov/niosh/twh

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