Table of Contents
Preface xix
Author Biographies xxiii
1 Total Worker Health®: Introduction and Overview 1
Deborah R. Roy
1.1 Introduction and Definitions 1
1.2 Five Elements of TWH 6
1.3 Hierarchy of Controls 9
1.4 Getting Started 11
1.5 Organizational Core Values 13
1.6 Identification of Metrics 14
1.7 Strategy 16
1.8 Tools for a Comprehensive Approach 19
1.9 Why Use the TWH Approach 20
1.10 Expanding OSH Practice 22
References 23
2 Risk Assessment for Total Worker Health® 27
Pam Walaski
2.1 Introduction 27
2.2 Fundamentals of Risk Assessment 29
2.2.1 Risk Identification 30
2.2.2 Risk Analysis 33
2.2.3 Risk Evaluation 34
2.3 General Risk Assessment Tools 36
2.3.1 Risk Identification Tools 36
2.3.2 Risk Analysis Tools 37
2.3.3 Risk Evaluation Tools 39
2.4 Tools Specific to TWH 39
2.5 Identifying the Top Risks to Worker Well-being in an Organization 41
2.6 Essential Elements of Applying TWH 42
2.7 Managing TWH Risk Through Hierarchy of Risk Treatment 46
2.8 TWH in Practice Focusing on Risk Management 49
2.8.1 TWH for Opioid and Abuse of Other Substances 49
2.8.2 Tobacco Use 50
2.8.3 Worker Burnout 51
2.8.4 Health Literacy 52
2.9 Conclusion 54
References 55
3 Connecting the Dots: ESG/Sustainability, Human Capital, and Total Worker Health® 59
Kathy Seabrook
3.1 Introduction 59
3.2 The Case for People, Human Capital, and Total Worker Health® 59
3.3 The Purpose of People 61
3.4 What is ESG and Sustainability-Related Risk? 62
3.5 The People, Employees, Workers, and Human Capital Connection 63
3.6 Integrating into the Business 65
3.7 More about the #TrueNorthTest 66
3.8 People and TWH Value Creation 68
3.9 Jacobs: One Million Lives 70
3.10 Where to Start the ESG, Sustainability, Human Capital, and TWH Journey? 71
3.11 Keys to Success: Integrating TWH, HC, ESG, and Sustainability 71
3.12 Mapping It Out 72
3.13 Risk Management and Covering Your Bases 74
3.14 Integrated Risk Management 75
3.15 Integrated Reporting, Materiality Assessment, and Decision-Making 76
3.16 Summary and Conclusion 79
References 81
4 Bringing Total Worker Health® into the Boardroom 85
Fay Feeney
4.1 Introduction 85
4.2 Human Capital Management 85
4.3 Board Structure and TWH 91
4.4 Vuca 92
4.5 Five Business Risks and TWH 93
4.6 The Business and Regulatory Environment Applied to TWH 94
4.6.1 ISO 45001:2018 – Occupational Health and Safety Management Systems – Requirements with Guidance for Use 98
4.7 What Safety and Health Professionals Need to Know About Corporate Governance 99
4.8 Advocating for TWH by Engaging the C-Suite 100
4.8.1 Concerns the CEO Must Evaluate 100
4.8.2 Questions Directors May Ask 101
4.8.3 ROI as Support 102
4.8.4 Topics Safety Professionals Can Bring into the Boardroom 103
4.9 Understanding What Business Leaders Care About 105
4.10 Becoming an Indispensable Partner Across the Organization 105
4.10.1 Materiality 106
4.11 Advancing TWH with CEOs and Boards of Directors 106
4.12 TWH and the Future 107
4.13 Bringing TWH into the Boardroom 108
References 109
5 Total Worker Health® and Insurance 111
Christine Sullivan
5.1 Introduction 111
5.2 Types of Insurance 113
5.2.1 Workers’ Compensation Insurance 113
5.2.2 Transitional Duty 115
5.2.3 Implementing a Return-to-Work Program 116
5.2.4 Americans with Disabilities Act 117
5.3 Health Insurance 118
5.3.1 Employee Assistance Programs as Part of a Total Worker Health® Program 118
5.4 Evaluating Your Insurance Program 120
References 121
6 TWH in Safety and Human Factors Accident Investigations and Development of Safety Interventions and Strategies 123
Rosemarie Figueroa-Jacinto
6.1 Introduction to Total Worker Health®, Safety, and Human Factors/Ergonomics 123
6.2 Sample Domains Within HF/E: 124
6.3 TWH Applied to Accident/Incident Investigations 125
6.4 Life Cycle of an Accident Investigation – Outside of Litigation 128
References 132
7 Technology Interventions and Support for Total Worker Health® 135
Linda Tapp
7.1 Introduction 135
7.2 Technology as Part of a TWH Program 137
7.3 Health and Safety Applications (Apps) to Support TWH 140
7.3.1 Physical Health Management Platforms 141
7.3.2 Mental Health Management Platforms 142
7.3.3 Health-Related Communication and Employee Education Management Platforms 142
7.4 Wearable Technology for TWH 143
7.4.1 Wearable Stress Trackers 148
7.4.2 Smart Clothing and Personal Protective Equipment (PPE) 148
7.4.3 Exoskeletons 149
7.4.4 Roadblocks and Hurdles 151
7.5 The Role of Gamification 152
7.5.1 Using Personas, Game Mechanics, and Motivators in a TWH Program 154
7.5.1.1 Personas 154
7.5.1.2 Game Mechanics 154
7.5.1.3 Motivators 154
7.5.1.4 Storytelling 156
7.6 Conclusion 156
References 156
Endnote 162
8 Ergonomics, the Aging Workforce, and Total Worker Health® 163
Rachel Michael
8.1 Introduction to an Aging Population 163
8.2 Introduction to Workplace Ergonomics 166
8.2.1 Summary 167
8.3 Ergonomics Programs 167
8.3.1 Regulatory Environment and Program History 168
8.3.2 Why Ergonomics Efforts in Health and Safety Programs Fail 172
8.4 Ergonomics as a Leading Indicator for TWH 174
8.5 Ergonomics, Ageing, TWH, and Business Metric Alignment 175
8.6 Ergonomic Design for an Aging Workforce 178
8.6.1 Physical and Cognitive Design Considerations 178
8.7 TWH Implementation Guideline as a Framework for Improved Ergonomics 186
8.8 Designing for the Future 188
References 191
9 Mental Health and Total Worker Health® 193
Subena Colligan
9.1 Introduction 193
9.2 Understanding Mental Health 195
9.3 Reasons for Mental Health Conditions 197
9.4 The Advantages of Addressing Mental Health in the Workplace 198
9.5 Mental Health and Safety in the Workplace 200
9.5.1 Physical Harm 201
9.5.2 Injuries and Accidents 201
9.5.3 Chronic Health Conditions 202
9.5.4 Psychological Harm 202
9.5.5 Excessive Workload and Burnout 202
9.5.6 Lack of Psychological Safety 202
9.5.7 Job Insecurity 202
9.5.8 Discrimination and Prejudice 203
9.6 Burnout and the Toll of Toxic Workplaces 203
9.6.1 Toxicity in the Workplace 205
9.7 Rest 206
9.8 Approaches to Promote Mental Well-being in the Workplace 207
9.8.1 Establishing a Mental Health Policy 207
9.8.2 Offer Mental Health Training 207
9.8.3 Consider Collaborating with Mental Health Providers 208
9.8.4 Alternative Work Arrangements 208
9.8.5 Employee Assistance Programs 208
9.8.6 The Importance of Breaks 209
9.8.7 Promote Supportive Work Environments 209
9.8.8 Encourage Communication 209
9.8.9 Provide Mental Health Resources 209
9.8.10 Enable Adequate Rest 209
9.9 Cultivating Mental Health in the Workplace 210
9.9.1 Encouraging Support from Top Management 210
9.9.2 Encourage Employee Involvement 210
9.9.3 Acknowledge Mental Health Awareness Days 211
9.9.4 Incorporate into the Mission 211
9.9.5 Encourage Work–Life Balance 211
9.10 Future Directions in Mental Health and Total Worker Health 211
9.11 Assessing Mental Health Programs 212
9.11.1 Clearly Define Objectives 213
9.11.2 Seek Employee Feedback 213
9.11.3 Analyze Data and Metrics 213
9.11.4 Collaborate with Mental Health Experts 213
9.12 Conclusion: The Significance of Addressing Mental Health in the Workplace 213
References 214
10 Total Worker Health® for a Remote Workforce 217
Tanya M. Conole
10.1 Introduction 217
10.2 What Is Remote Working and Who Is a Remote Worker? 218
10.2.1 What Is Remote Working? 219
10.2.2 Who Is a Remote Worker? 219
10.3 Balancing the Equation 220
10.4 The Impact of Physical Isolation on the Remote Workforce 222
10.4.1 Organizational Isolation and Loss of Workplace Social Connectivity 222
10.4.1.1 Organizational Isolation 223
10.4.1.2 Loss of Workplace Social Connectivity 224
10.5 Impact on Workforce Performance and TWH 226
10.5.1 Gathering Information and Obtaining Assistance 226
10.5.2 Loss of Soft Information (Social Cues) Regarding Workload and Progress 227
10.5.3 Collaboration 228
10.5.4 Decision Making, Work Allocation, and Performance Evaluations 228
10.6 The Dual Edges of Remote Work 230
10.7 Alternatives to in-Person Conversations and Their Impact on Remote Workers TWH 230
10.7.1 Quality of Communication 231
10.7.1.1 Why Is the Quality of Communication So Important for Remote Workers? 231
10.7.1.2 In-Person Communication 232
10.7.1.3 The Impact of Virtual Meetings on the Quality of Communication 233
10.7.1.4 Eye Contact 234
10.7.1.5 The Impact of Email and Text on the Quality of Communication 235
10.7.2 The Willingness to Speak up or Contribute 236
10.7.2.1 Isolation 236
10.7.2.2 Speaking up and Not Being Heard 237
10.7.3 Meeting Fatigue 239
10.7.3.1 An Increase in Meetings in the Same Amount of Hours … Or More 239
10.7.3.2 Time Zone Challenges 240
10.7.3.3 Back-to-Back Meetings 241
10.7.3.4 The Impact of Screen-Based Communication Tools 242
10.8 Other Considerations 243
10.8.1 Burnout 243
10.8.1.1 What Is “Burnout”? 243
10.8.1.2 Prevalence of Burnout 243
10.8.1.3 Symptoms of Burnout 244
10.8.1.4 Burnout and the Remote Worker 244
10.8.1.5 Responsibility for Management and Control 245
10.8.2 Technology Issues 246
10.8.3 Longer Screen Time and a More Sedentary Lifestyle 247
10.8.3.1 Longer Screen Time 247
10.8.3.2 A More Sedentary Lifestyle 248
10.8.4 Impact of Isolation on TWH Programs 250
10.8.5 Impact of Isolation on TWH Program Training 251
10.9 Personal Adjustment to the “Remote Work” Style 252
10.9.1 Sharing the Workplace with Family 252
10.9.2 Location 253
10.9.3 Ergonomics 253
10.9.4 Inability to Disconnect 253
10.9.5 Compatibility 254
10.10 Solutions 255
10.10.1 Take Stock, Change, and Communicate 255
10.10.2 Is a Hybrid Working Model Right for the Organization? 256
10.10.2.1 Different Hybrid Working Models 256
10.10.2.2 Factors to Consider 257
10.10.3 Normalize Meeting Declines and Remote Workers Being Unavailable 258
10.10.4 Other Tangible Solutions 259
10.11 Conclusion 262
References 263
11 Safety Committee Involvement in Total Worker Health® (twh) 267
Angela C. Ray
11.1 Introduction 267
11.2 What Does a Dynamic Safety Committee Look Like? 267
11.2.1 Clear Purpose 268
11.2.1.1 “Baking” with Purpose 268
11.2.2 Developing a Clear Purpose 269
11.2.2.1 Gather Information 269
11.2.2.2 Review, Discuss, and Decide 269
11.2.2.3 Refine and Share 269
11.2.3 Trust 270
11.2.4 Useful Communication 272
11.2.5 Follow-Through 273
11.2.6 Visibility 274
11.3 Types and Structure 275
11.3.1 Executive Safety Committee 275
11.3.2 Employee Safety Committee 276
11.3.3 Structure 277
11.3.4 Members 278
11.3.5 The Name 278
11.3.6 Bylaws 278
11.3.7 Budget 280
11.3.8 Meetings 280
11.3.9 Subcommittees 280
11.3.10 Action Item Log 281
11.3.11 Annual Training 281
11.4 Participation 281
11.4.1 The Complaint Spiral 282
11.4.1.1 Solutions to Prevent the Complaint Spiral 284
11.4.2 The Bad Actors 284
11.4.3 Develop Leaders 285
11.4.4 Perspective Shift 285
11.4.5 Deploy the Five Whys 286
11.4.5.1 Five Whys 286
11.4.6 Provide Training 287
11.5 Practical Tips within the TWH Framework 287
11.5.1 Defining Element 1: Demonstrate Leadership Commitment to Worker Safety and Health at All Levels of the Organization 287
11.5.1.1 Give EmSC a Budget 287
11.5.1.2 Provide a C-Suite Ally and Support the EmSC Mission 288
11.5.1.3 Provide a Welcome Package 288
11.5.1.4 Invest in Quality Safety and Health Training 289
11.5.1.5 Safety Day 289
11.5.2 Defining Element 2: Design Work to Eliminate or Reduce Safety and Health Hazards and Promote Worker Well-Being 290
11.5.2.1 Hazard Assessments Reviewed by EmSC 290
11.5.2.2 Flexible Work Schedules 290
11.5.2.3 Job Demands Analysis 291
11.5.3 Defining Element 3: Promote and Support Worker Engagement Throughout Program Design and Implementation 291
11.5.3.1 Safety Committee Member Involvement in OSH Department Activities 291
11.5.3.2 Healthy Workplace Participatory Program (HWPP) 292
11.5.3.3 EmSC Annual Training and Team-Building Session 292
11.5.4 Defining Element 4: Ensure Confidentiality and Privacy of Workers 293
11.5.4.1 Use the EmSC to Collect Safety Concerns 293
11.5.4.2 Safety Suggestion Box 293
11.5.4.3 EmSC Members Only Time 293
11.5.5 Defining Element 5: Integrate Relevant Systems to Advance Worker Well-Being 294
11.5.5.1 Employee Safety Surveys 294
11.6 Stretch and Flex Program Makeover … Mobility Program 295
11.6.1 Stretch and Flex Metric 295
11.7 Challenge Workplace Norms 296
11.7.1 Challenging Norms Metrics 297
11.8 Conclusion 297
References 297
12 Behavior Change Strategies and Tactics in Total Worker Health® Programs 301
Devon Tapp
12.1 Introduction 301
12.2 Introduction to Behavior Change Strategies 301
12.3 Assumptions of Behavior Change 302
12.4 Paths of Behavior Change: Motivational Interviewing 303
12.5 Motivational Interviewing Components 304
12.5.1 The Spirit of Motivational Interviewing 304
12.5.2 Oars 304
12.5.3 Communication Style 306
12.5.4 REDS Principles 307
12.5.4.1 Roll with Resistance 307
12.5.4.2 Express Empathy 307
12.5.4.3 Develop Discrepancy 308
12.5.4.4 Support Self-efficacy 308
12.6 The Process of Motivational Interviewing 309
12.7 Putting It All Together: A Motivational Interviewing Case Study 311
12.8 Learning from Related Fields 313
12.9 Summary 315
References 316
13 Total Worker Health® and Construction 319
Tricia Kagerer
13.1 Introduction 319
13.2 The Various Construction Risks That TWH Could Solve 320
13.2.1 Reputational Risk 321
13.2.2 Workforce Challenges 321
13.2.2.1 Aging Workforce 321
13.2.2.2 Physical Demands 322
13.2.2.3 Drug Addiction 322
13.2.2.4 Immigration Laws 324
13.2.3 Mental Challenges 326
13.2.4 Diversity Equity and Inclusion Challenges 328
13.3 Conclusion and Best Practices 329
13.3.1 Total Worker Health® – Solving the Legacy of Risk in the Construction Industry 329
13.3.1.1 Work Right NW 331
13.3.1.2 Turner Construction 332
13.3.1.3 Jordan Foster Construction 333
13.3.1.4 Nabholz Construction 335
13.4 The Future of Construction Depends on TWH 337
References 338
14 Total Worker Health® in the Transportation Industry 341
Alexi Carli
14.1 Industry Overview and Impact 341
14.2 Jobs and Risks 342
14.2.1 Road Transportation 342
14.2.1.1 Trucking 342
14.2.1.2 Couriers, Messengers, and Postal Workers 344
14.2.1.3 Transit and Ground Passenger/Scenic and Sightseeing 344
14.2.1.4 Warehousing and Storage 344
14.2.2 Air Transportation 345
14.2.2.1 Airlines 345
14.2.3 Rail Transportation 346
14.2.4 Maritime Transportation 347
14.2.4.1 Water 347
14.2.4.2 Harbor 348
14.3 Supporting Worker Safety, Health, and Well-Being in Transportation 348
14.3.1 Fatigue Management 348
14.3.2 Compounding Health Issues 352
14.4 Case Studies 353
14.4.1 Schneider National 354
14.4.2 J.B. Hunt 355
14.4.3 Health and Sustainability 356
14.4.4 Mental Health and Work Stress 356
14.4.5 Purolator 358
14.4.6 Amazon 359
14.4.7 Work Preparation and Conditioning 359
14.4.8 Ups 360
14.5 Driving Occupations 360
14.5.1 Acclimatization 361
14.5.1.1 Purolator 364
14.5.2 Technology and Automation 364
14.5.2.1 Amazon 365
14.5.2.2 Ups 366
14.5.2.3 FedEx 366
14.5.2.4 Shipyard and Rail Terminal Automation 367
14.6 The Path Forward – Considerations for Transportation Worker Health and Well-Being 367
References 369
15 Total Worker Health® and Manufacturing 375
Monique Parker
15.1 Introduction 375
15.2 Impacts of Manufacturing 376
15.3 Environmental Factors 378
15.4 Interventions 380
15.4.1 Osha 380
15.4.2 Knowledge 380
15.4.3 Work Environment 382
15.5 Worker Benefits 384
15.6 Challenges 386
15.7 Strategies 388
15.7.1 Top Leaders 388
15.7.2 Working Committees 389
15.7.2.1 The Education/Training Committee 389
15.7.2.2 The Development Committee 390
15.7.2.3 The Engagement Committee 390
15.7.2.4 The Support Committee 391
15.7.2.5 The Technical Committee 392
15.8 Summary 392
References 393
16 Case Studies Related to Total Worker Health® 395
Linda Tapp
16.1 Introduction 395
16.2 Case Studies and Management Support 395
16.3 Lessons Learned 396
16.4 Case Studies and Lessons Learned in Learning and Development 397
16.5 Total Worker Health® Case Studies in This Book 398
16.5.1 Case Study Summary: L.L.Bean 398
16.5.1.1 About 398
16.5.1.2 Challenge 398
16.5.1.3 Solution 399
16.5.1.4 Outcome 399
16.5.2 Case Study Summary: L’Oréal 399
16.5.2.1 About 399
16.5.2.2 Challenge 400
16.5.2.3 Solution 400
16.5.2.4 Outcome 400
16.5.3 Case Study Summary: Mental Health Initiative at Jacobs 400
16.5.3.1 About 400
16.5.3.2 Challenge 401
16.5.3.3 Solution 401
16.5.3.4 Outcome 401
16.5.4 Case Study Summary: Turck 401
16.5.4.1 About 401
16.5.4.2 Challenge 401
16.5.4.3 Solution 402
16.5.4.4 Outcome 402
16.5.5 Case Study Summary: Children’s Hospital Colorado 402
16.5.5.1 About 402
16.5.5.2 Challenge 402
16.5.5.3 Solution 402
16.5.5.4 Outcome 403
16.5.6 Case Study Summary: Morrison Utility Services 403
16.5.6.1 About 403
16.5.6.2 Challenge 403
16.5.6.3 Solution 403
16.5.6.4 Outcome 404
16.5.7 Case Study Summary: Turner Construction 404
16.5.7.1 About 404
16.5.7.2 Challenge 404
16.5.7.3 Solution 404
16.5.7.4 Outcome 404
16.5.8 Case Study Summary: Schneider Transportation 405
16.5.8.1 About 405
16.5.8.2 Challenge 405
16.5.8.3 Solution 405
16.5.8.4 Outcome 405
16.6 Additional Case Study Summaries Related to Total Worker Health® 405
16.6.1 Case Study Summary: Trucks, Inc. 406
16.6.1.1 About 406
16.6.1.2 Challenge 406
16.6.1.3 Solution 406
16.6.1.4 Outcome 406
16.6.2 Case Study Summary: Waste Management, Inc. 407
16.6.2.1 About 407
16.6.2.2 Challenge 407
16.6.2.3 Solution 407
16.6.2.4 Outcome 407
16.6.3 Case Study Summary: Remote Worker Challenges 407
16.6.3.1 Remote Worker – “TC” 407
16.6.3.2 Challenge 408
16.6.3.3 Impact 408
16.6.3.4 Solutions 408
16.6.3.5 Outcome 408
16.6.4 Case Study Summary: White Construction Group (WCG) 409
16.6.4.1 About 409
16.6.4.2 Challenge 409
16.6.4.3 Solution 409
16.6.4.4 Outcome 409
16.6.5 Case Study Summary: 3M Manufacturing Plant 410
16.6.5.1 About 410
16.6.5.2 Challenge 410
16.6.5.3 Solution 410
16.6.5.4 Outcome 410
16.7 Additional Case Studies 410
References 411
17 Resources 413
Linda Tapp
17.1 Websites 413
17.2 NIOSH Worker Wellbeing Questionnaire (NIOSH WellBQ) 414
https://www.cdc.gov/niosh/twh/php/wellbq 414
17.3 Centers of Excellence for Total Worker Health® 415
17.4 Resources from Membership Organizations 416
17.5 Calculators 416
17.6 Recommended Books 419
Index 421
