Creating a Culture of Health and Engagement Through Organizational Support

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1 Creating a Culture of Health and Engagement Through Organizational Support A healthy culture is intentionally designed with elements and indicators that support health and well-being. 1 Creating a culture of health and engagement is an important initiative for many organizations in In fact, many 2014 industry surveys on health care strategy revealed that developing a workplace culture of health is a top priority for employers this year. 2 To achieve this goal, plan sponsors need to learn from other disciplines such as organizational development, positive psychology and behavioral economics to evaluate their culture, systems and drivers of organizational behavior related to health. These organizational dynamics not only impact employee engagement, but also are believed to impact employees engagement in their health and the programs developed to support their health and well-being. Healthy Workforce Culture Recently, the Health Enhancement Research Organization (HERO) 3 convened more than 40 practitioners to define the attributes of a healthy workplace culture. This group identified 24 elements, shown in Table I, that help create a culture of health within an organization. As illustrated by the breadth of these elements, a healthy workforce culture is defined by many intangible characteristics. It has been suggested that a culture of health reflects prevailing values and expectations of employees in order to effectively influence the way they think, feel and behave related toward personal and group health. 4 Creating a culture of health involves recognizing the influence of workplace norms, values, beliefs and traditions on each individual s choice to engage in his or her own health. In addition, it is critical to recognize how the workplace climate, environment and resources can provide the opportunity to engage in healthy behavior. Finally, workplace policies and procedures, employee involvement, rewards and recognition, training and development influence health behaviors and beliefs. This underscores the complexity and systemic nature of creating a culture of health. 44

2 MAGAZINE Reproduced with permission from Benefits Magazine, Volume 52, No. 6, June 2015, pages 44-48, published by the International Foundation of Employee Benefit Plans ( Brookfield, Wis. All rights reserved. Statements or opinions expressed in this article are those of the author and do not necessarily represent the views or positions of the International Foundation, its officers, directors or staff. No further transmission or electronic distribution of this material is permitted. pdf/515 by Jennifer Flynn The Health Enhancement Research Organization and Population Health Alliance have collaborated on a guide to help employers measure support for health and well-being. june 2015 benefits magazine 45

3 Table I HERO Healthy Workforce Culture Elements Norms Shared values Executive leadership Organizational leadership Communications Recruitment and selection Metrics and measurement Policies and procedures Supportive or built Organizational resource Employee involvement Rewards and recognition (physical) environment allocation and commitment and empowerment Peer support Pushback Sense of community Shared vision and mission Positive outlook Modeling Orientation and first impressions Training and learning Relationship development Traditions and symbols Internal customer orientation External community connections and altruism Organizational Support Considering its broad nature, creating a healthy workforce culture becomes more challenging for employers as they try to demonstrate the effectiveness of their initiatives. HERO and the Population Health Alliance (PHA) formed a joint committee to identify measures to help companies assess organizational support for health and well-being. The committee defined steps an organization can take and identified ways to measure the effectiveness of their efforts. These are outlined in the recently published Program Measurement & Evaluation Guide: Core Metrics for Employee Health Management. 5 From the guide, employers can learn the steps to make << bio Jennifer Flynn is a strategy consultant for Mayo Clinic Global Business Solutions, where she advises companies on health management best practices, industry trends, strategic planning, culture of health, organizational support, program design, engagement and evaluation of their population health management programs. She is a member of the HERO steering committee commissioned by Robert Wood Johnson Foundation to identify culture of health metrics for the nation, leads the HERO Culture of Health research work group and is the vice chair of the HERO research subcommittee focused on advancing EHM research. Flynn holds a B.A. degree in psychology from Denison University and a master s degree in health management from American University. She is working toward a Ph.D. degree in industrial/ organizational psychology. the healthy choice the easy and desired choice within the workplace. These steps incorporate management policies and practices that involve, empower and engage employees in decisions about their work, health, safety and the business. Such an environment makes it easy and expected for employees to engage in healthy and safe behaviors. These eight elements define the necessary support a company must provide to be most successful: 1. Company-stated health values 2. Health-related policies 3. Supportive environment (the physical or built workplace environment) 4. Organizational structure 5. Leadership support 6. Resources and strategies (adequate employee health management (EHM) services, budget, communication, etc.) 7. Employee involvement (employees have an opportunity for input and evaluation) 8. Rewards and recognition. In addition, employee needs and values should guide how an organization chooses to initiate or provide this support. In other words, organizations need to Assess what resources and support elements employees need and desire to help them prioritize their health and well-being at the workplace. Identify what managers and leaders require to effectively support their employees in the area of health and well-being. Identify training and development needs to educate managers and leaders on better supporting their subordinates in this important area. In sum, the first step in providing strong organizational support is conducting a needs assessment. Whether this information is collected through surveys, focus groups, town 46

4 Table II Best Practice Assessment Tools Instrument HERO Best Practice Scorecard in Collaboration with Mercer* CDC Worksite Health Scorecard* Environmental Assessment Tool Well Workplace Checklist Dimensions of Corporate Well-Being Survey HealthLead Checklist of Health Promotion Environments at Worksites (CHEW) Worksite Wellness StrengthsBuilder HECheck *Public domain tools. Focus Area Best practice design and self-reported outcomes Evidence-based interventions assessment Physical and social environment assessment for obesity prevention Results-oriented benchmarking tool Assessment of program and policy dimensions Organizational engagement, well-being, outcomes best practice assessment Environmental features associated with physical activity, healthy eating, alcohol use and smoking Opportunity-based assessment and action plan Workplace evaluation of policies, services, facilities and programs Table III Organizational Support and Culture Assessment Tools Instrument Focus Area Lifegain Health Culture Audit (LHCA) Cultural support for avoiding health risk behaviors Worksite health climate scales Organizational support, interpersonal support and health norms Organizational health and safety climate scales Safety and health climate of worksite Perception of environmental and cultural support for health survey Centers for Disease Control National Healthy Worksite Program Health and Safety Climate Survey* Leading by Example (LBE) instrument* Perceived Organizational Support Survey *Public domain tools. Employee and manager perceptions of workplace environment and culture Employee perception of health and safety climate within the workplace Manager perception of leader support for healthy work culture and health programs Employee perception of organizational support hall meetings or water cooler conversations, it is imperative that employee needs and values shape an organization s efforts. As noted, an organization needs to measure the effectiveness of each effort and determine whether the support employees received is making a difference in their ability to manage their health and well-being. It is also important to confirm that managers and leaders believe they have access to the resources they need to support others within the organization. These measurement recommendations stem from what is known as perceived organizational support (POS). The organizational support theory suggests employees have a global belief about how their employer values their contributions and cares for their well-being. 6 During the last 30 years, research has demonstrated that a positive relationship exists between POS and employee satisfaction, engagement, motivation and performance. More specifically, POS and health support have been shown to positively impact safety behavior. 7 Considering this evidence, it is believed that high levels of POS for health and well-being would positively impact health behavior and encourage individual health engagement. Measuring employee, manager and leader POS provides insight into the degree to which employee well-being is encouraged and supported. It is recommended that employers measure both their level of organizational support and the degree to which their employees, managers and leaders perceive both that health is a priority for the business and that they are supported by their employer organization. To accomplish this, these measures would include the assessment of: 1. The organizational support elements the employer has june 2015 benefits magazine 47

5 taken to create an environment that supports health and well-being 2. Employee-perceived level of organizational support for health and well-being 3. Leader-perceived level of organizational support for health and well-being and the perceived level of POS to support others in their health and well-being. Based on this guidance, employers are encouraged to identify tangible ways to support the health and well-being of employees and their family members. These may include including health goals into annual or company goals, leaders modeling healthy behaviors at work, policies that reflect health as a priority and recognition for employees, managers and leaders for prioritizing health. In addition, employers are prompted to use key measures to evaluate their investments and ensure their efforts are fruitful. Although the workplace culture is defined by intangible characteristics, there are concrete, tangible ways to measure perceptions and glean valuable insights on program effectiveness. Practical Resources and Assessment Tools As noted, creating a culture of health requires a concerted effort, and there are practical resources that can help. Specifically, assessment tools that educate on and assess the use of employee health management best practices, as well as POS for health and well-being, can help an organization establish a baseline for a healthy workplace culture and employee perceptions. Assessing the current state is the first step in this strategic effort. Table II outlines tools available to allow an organization to assess best practices including organizational support elements. Two of these assessment tools are public domain and may be used free of charge. Multiple tools also are available to help employers assess the perceived cultural and organizational support of health and well-being. These assessments include employee perception as a key measure, and some differentiate between employee, manager and leader perceptions. Like the best practice assessment tools, public domain options are available and described in Table III. Current Industry Initiatives Great strides over the past few years have helped to better define a culture of health, understand the elements of a healthy workplace culture and use them to create programs and identify measures to assess program effectiveness. Despite these accomplishments, practitioners have just begun to better understand the connection between organizational dynamics and individual health, well-being and performance, and more efforts are underway. The HERO Culture of Health Committee is managing a comprehensive effort to catalogue and review hundreds of research studies that have either implemented or evaluated a culture-of-health element within the workplace and have demonstrated a health or safety outcome. The goal is to provide a landscape view of efforts to date. For more information on this initiative, visit Another significant effort is the Robert Wood Johnson Foundation (RWJF) Culture of Health Measurement Initiative. This effort is focused on fulfilling the foundation s mission to create a culture of health within our nation. To assess employers commitment to creating healthy communities, RWJF plans to include criteria from the Program Measurement & Evaluation Guide: Core Metrics for Employee Health Management for the purpose of establishing national metrics. 8 Conclusion Developing a healthy workplace culture is essential in order to optimally support individuals in their personal health management. Identifying strategies that positively influence employee decisions about their health, work, safety and the business, while enhancing organizational culture, systems and drivers of health behavior, is an area of great interest and promise. Endnotes 1. HERO Culture of Health Committee, /2014 NBGH/Towers Watson Staying@Work Survey Report; The Willis Health and Productivity 2014 Survey Report; 18th Annual Towers Watson/NBGH Survey on Purchasing Health Care, HERO Culture of Health work group. 4. S. G. Aldana et al. (2012). A review of the knowledge base on healthy worksite culture. Journal of Occupational and Environmental Medicine, April (4), pp HERO/PHA Program Measurement & Evaluation Guide: Core Metrics for Employee Health Management, Available at /wp-content/uploads/2015/02/hero-pha-metrics-guide-final.pdf. 6. L. Rhoades and R. Eisenberger. Perceived organizational support: A review of the literature. Journal of Applied Psychology, 87(4), K. J. Mearns and T. Reader. (2007). Organizational support and safety outcomes: An un-investigated relationship. Science Direct, 46, Information about the HERO/PHA Measurement and Evaluation Guide is available at 48