Healthy organisations: definitions, models, empirical evidence

Introduction

This article will begin by providing definitions of healthy organisations and key conceptual components and principles underpinning this concept. Available good practice models of healthy workplaces will be outlined and discussed, while key elements underpinning healthy organisations will be identified and compared. Finally, implementation issues underpinning the development and cultivation of healthy workplaces will be outlined and discussed.

What is a healthy organisation?

Definition

The World Health Organization (further referred WHO) ^[1] defines health as ‘a state of complete physical, mental and social wellbeing, and not merely the absence of disease’. All definitions of a healthy organisation should, therefore, ideally encompass this diverse view. In reviewing the available evidence ^[1], it becomes apparent that definitions of healthy organisations have evolved from a focus on the physical work environment (e.g. dealing with chemical, physical and biological hazards) to include psychosocial factors (e.g. workplace culture and work organisation), health practice issues (lifestyle) and a connection with the community. All of these factors can have a profound impact on the health of employees and the wider community and should be defining components/ dimensions of a healthy organisation.

Key components

Two key components of organisational health, as discussed in the literature, are the health of employees and the performance of the organisation ^[2]. Therefore in the broadest sense, healthy workplaces can be viewed as: employee health + organisational health = healthy workplaces. For the attainment of a healthy workplace, consideration needs to be paid to the individual as well as the organisation. However, moving beyond this conceptualisation, current models also refer to the consideration of the impact of an organisation’s activities on the community in which it operates ^[3][4]. In modern society, organisations are expected to act responsibly and contribute to the wider health, safety and wellbeing of their community ^[4].

Guiding principles

Adkins, Quick and Moe proposed four guiding conceptual principles underpinning the notion of organisational health ^[2]. Firstly, health is on a continuum with mortality at one end, and vibrant wellbeing on the other. Therefore from an organisational perspective, organisational health is more than just implementing practices and actions that strive to prevent negative outcomes, but rather should work to promote positive health outcomes as well. The second proposed principle postulates that an organisation health is not state, but is a process. More specifically, a healthy organisation is conceptually viewed not as an obtainable state, but rather is defined by a continuous process of improvement (including, continuously monitoring, evaluating and further developing implemented actions).

Organisational health is the result of many complex connections between numerous different factors. Therefore, the third conceptual principle is organisational health can exist only if all of the organisation parts and systems aim to be free of disease and illness as a foundational component. Therefore, a key guiding, and arguably foundation principle, is the importance of eliminating or minimising damaging factors are eliminated or minimised by conducting a thorough risk assessment.

In organisations, actions are achieved through relationship-building, collaboration and constant communication. Therefore, the final guiding principle to organisational health is a concentrated focus on developing and cultivating fulfilling relationships, which aid the individual and the organisation to thrive and flourish. As it will be discussed and highlighted throughout this article, the four guiding principles to organisational health as proposed by Adkins and colleagues ^[2] conceptually co-align with the existing good practice models of healthy organisations.

The evidence base on healthy organisations

Kelloway and Day ^[5] argue that organisational health is not solely the result of the absence of ‘stressors’ in the working environment, but also the result of the existence of resources provided by the organisation that enable employees to handle these job stressors. Since research has revealed the vast human and financial costs associated with poor organisational health ^[6] it is unsurprising that many organisations spend energy and time designing, implementing and monitoring programmes to improve organisational health. Grawitch, Gottschalk and Munz ^[3] conducted a critical review to determine which policies and programmes contributed to improving organisational health. The authors defined an integral concept of organisational health, outlining what organisations can do to develop such working environments. They found that five categories of healthy workplaces practices existed in the literature: employee growth and development, work-life balance, employee involvement, health and safety and recognition. Grawitch and colleagues ^[3][7] also found that the relationship between these five practices and both individual and organisational outcomes are dependent on communication effectiveness in the organisation, and also on aligning the workplace practices within their social/ organisational context.

Models and conceptual frameworks of healthy organisations/workplaces

EU-OSHA & ILO conceptual frameworks for healthy workplaces

European Agency for Safety and Health The European Agency for Safety and Health (EU-OSHA) at work highlights that risk prevention is fundamental to the development of a healthy workplace ^[8]. Central to the practice of risk prevention is conducting a risk assessment and having a proper risk management in place; whereby, risks can be identified, managed and monitored. EU-OSHA places particular emphasis on the significance of top management leadership and employers working together with active employee participation to aid in risk prevention ^[8], and this is viewed as a central component of a healthy workplace. Besides complying with the law and doing proper risk management, the EU-OSHA emphasises the importance of Workplace Health Promotion of employees.

EU-OSHA has since 2000 been organising their ‘Health Workplaces Campaigns’ ^[9], which encompass the framework above. These campaigns are the Agency’s primary tools for raising awareness of issues related to occupational safety and health, and promoting the idea that good health and safety is good for business. Running for a two year duration, the campaign in 2012-13 focused on ‘working together for risk prevention – leadership and worker participation’ ^[10]. This campaign emphasises the elimination or control of workplace risks by creating effective management and encouraging worker participation. The health campaign for 2008-2009 focused on raising awareness on risk assessment as the cornerstone of health and safety management in the workplace, including the importance of considering psychosocial risk assessments ^[10]. While evidently emphasising risk assessments, this campaign also encompasses other aspects of workplace health promotion including involving workers, implementing prevention measures, engaging employers/managers and evaluating changes ^[11].

The International Labour Organisation The International Labour Organization (ILO) ^[12] also focuses on risk prevention in the working environment, and incorporates mental health and wellbeing in its proposed actions and measures for workplace health promotion. More specifically, the ILO proposed a framework for the development of a healthy workplace, includes several key considerations:

• First, the organisation’s policies on health and safety should be broadened to include psychosocial hazards in risk assessment measurements.
• Second, psychosocial risks in the working environment should be evaluated through risk assessment.
• Third, specific needs should then be identified, and measures taken.
• Finally, workplace actions should be implemented through preventative measures.

This framework suggests that a healthy workplace can be cultivated through several procedural stages and practices, including: policy, organising, planning and implementation, evaluation and action for improvement.

• Policy: an OSH policy is developed that encourages worker participation.
• Organising: responsibility and accountability of staff is organised, along with any training, documentation and communication necessary.
• Planning and implementation: an initial review should be conducted, along with development and implementation of OSH objectives.
• Evaluation: performance monitoring and measurement is done under the evaluation process.
• Action for improvement: preventative and corrective action is taken to encourage continual improvement, thereby repeating the cycle again. Therefore, central to this proposed framework for developing healthy workplaces and organisations is the critical importance of the continual improvement cycle.

The ILO recommends that organisations should adapt the recommendations of this framework to their own country, workplace and culture. For example, ILO has developed the SOLVE training package, which uses policy design and action to focus on preventing psychosocial risk and promoting health and wellbeing at work ^[13]. This training programme addresses nine topics which are grouped into three areas:

• Psychosocial health (stress; psychological and physical violence; economic stressors)
• Potential addictions (tobacco consumption; alcohol and drug consumption)
• Lifestyle habits (nutrition; exercise or physical activity; health sleep; HIV and AIDS)

Based on social dialogue, the SOLVE programme aims to integrate workplace health promotion into OSH policies by involving workers, employers, governments, public servants and NGOs ^[14]. It is important to note here that both the EU-OSHA and ILO approaches encompass many of the key elements from the WHO and NIOSH models presented below.

WHO ‘Healthy Workplaces’ model

The WHO framework for a healthy workplace identifies four ‘avenues of influence’ that should be considered and addressed by organisations in order to create a working environment that promotes, supports and protects the mental, physical and social wellbeing of employees [^[15]. See figure 1 for a graphic representation of this model for action. The four avenues of influence identified are: the physical working environment, the psychosocial work environment, personal health resources and enterprise community involvement. At the heart of the WHO model are the organisation’s ethics and values, which form the foundation of leadership and employee engagement ^[15]. In order to guide the way each of the four avenues is addressed, an assessment process involving consultation with employees and their representative(s) should be undertaken by organisations.

The four avenues of interests are the:

• Physical work environment, such as asbestos, machinery, pesticides, noise, excessive heat and awkward posture;
• Psychosocial work environment, including harassment, hours of work, excessive work demands, excessive workload, support, lack of two-way communication and job insecurity;
• Personal health resources, for example health services, supportive environment, resources, information and opportunities that an organisation provides to employees to motivate or support their efforts to maintain or even improve healthy personal lifestyles ^[15].
• Enterprise community involvement, as organisations exist within communities and are both affected by, and affect those communities ^[15].

Creating healthy workplaces: steps for action

In order to create a healthy workplace programme that is effective in meeting the needs of the employee and employer, the World Health Organisation^[15] has outlined a cyclic 8-step process of implementation that plans, acts, evaluates and improves on the programme activities.

Mobilize The first critical step is to mobilize and gain commitment from key opinion leaders and stakeholders in the organisation. Therefore, support, resources or permission are needed from senior management, union leaders or owners must be obtained before attempting to proceed.

Assemble The second step is to assemble a ‘healthy workplace team’, who will work on the implementation of change in the working environment. This team should include a variety of representatives from a variety of sectors and levels of the company. It may include human resource personnel, health and safety professionals and trade union representatives. At least half of the team should be non-management employees and attentions should be paid to gender representation.

Assess The third step is to assess both the present employee and organisation situation, along with the future outcomes that are desired. Data should be gathered on the demographics of employees, disability, work-related illnesses and injuries, productivity of the organisation, turnover and issues that have arisen from risk assessment processes. The present situation of employee health can be collected via health risk assessments and confidential surveys. To assess the desired future of the employee and organisation may involve benchmarking exercises to identify how other similar companies are scoring on the data previously discussed. A literature review may be important to find out about best practice. It is also important to ask employees about their opinions and ideas with regard to the improvement of the working environment and how they believe the employer can help.

Prioritise Once all the information has been gathered, the fourth step is for the healthy workplace team to prioritise the identified issues and deal with them in the appropriate order. This decision-making process should consider: the preferences and opinions of managers, employees and their representatives, as well as the risk to employees; whether there is a potential solution to the problem and how easy it is to implement; and also the cost of the problem if it continues to be ignored.

Plan The fifth step is to plan out the actions to be taken over the next three to five years. This plan should set out the activities that will address the problems that were prioritised and the timeframes for these actions. It should include long-term objectives so it is possible to tell if anything has been successful in the future, as well as the budget, resources and facilities required. Evaluation for each initiative should also be planned.

Implement The sixth step is to implement the action plans, with responsibilities having already been assigned in the previous stage. Employee involvement is crucial again at this stage, as is the demonstration of support and commitment from management for the specific policies or programmes.

Evaluate The seventh step is to evaluate in order to determine what is, and what is not, working and identify what is important for success. The process of implementation should be evaluated, as well as the short-term and long-term outcomes.

Improve The final step (or the first in the next cycle) is to improve and implement changes on the basis of the evaluation outcome, in order to improve the programmes and initiatives that have already been implemented.

NIOSH model

The National Institute for Occupational Safety and Health (NIOSH) in the United States suggests that there are four critical attributes for healthy workplaces ^[16]: (1) commitment to the values of the company; (2) management practices, including strong leadership, rewarding employees for high quality work and supportive supervisors; (3) and an organisational culture that makes employees feel valued and where group conflicts are resolved. This proposed framework for action suggests there are a number of ‘essential elements’ to a healthy workplace. These ‘essential elements’ can be broadly categorised into four broad areas: leadership and organisational culture, programme design, programme implementation and resources, and programme evaluation. The following section aims to highlight and discuss some of the key essential elements that should be considered in relation to each of the specified areas.

Leadership and organisational culture

NIOSH suggests that there are a number of essential elements that characterise optimal leadership and organisational culture ^[16]. Firstly, organisations should develop a culture that is human-centred, built on trust rather than fear; and encourages active employee input. Secondly, leadership should be demonstrated, and a commitment to the safety and health of employees should be reflected in actions and words. Finally, organisations should engage mid-level management by involving managers and supervisors at all levels in helping to promote any health-supportive programmes. These individuals are the links between upper management and employees and can help to determine the success of any programmes.

Programme design

The NIOSH framework for developing healthy organisations suggests that clear principles should be established to guide the programme design and allocation of resources as well as to focus priorities. Organisations should also integrate relevant systems, such as designing programmes initially involves an inventory and evaluation of policies and programmes relevant to wellbeing and health that already exist. Recognised hazards that exist in the workplace should be eliminated and organisations should be consistent by changing the working environment to be in alignment with health goals to enhance employee engagement in the programmes. Employees should be involved in identifying issues with health and safety as well as letting them contribute to the design, implementation and evaluation of programmes, as NIOSH argues that this is strategically the most effective way to change systems, behaviour and culture. Programmes should also be tailored to the specific workplace and needs of employees. Rewards and incentives should also be considered, such as time off, financial rewards and recognition for the participation in programmes, which may enhance employee engagement. The correct tools should also be used to measure baseline and subsequently track progress. Both organisational and individual health should be measured using valid and relevant measurement instruments. As interventions are likely to have unpredictable effects as well as the impact it is aiming for, programmes that are implemented must be adjusted based on any unanticipated effects that are detected through evaluation. Programmes should also be designed with a long-term outlook in order to guarantee sustainability. Finally, NIOSH suggests that confidentiality should be ensured ^[16].

Programme implementation and resources

NIOSH states that organisations should start small and scale up, and be prepared to discontinue pilot projects that are failing ^[16]. Organisations should also provide sufficient resources, identifying and engaging appropriately trained and motivated staff as well as allocating adequate resources such as time, space and staff in order to achieve results. Companies should also communicate strategically, informing all employees of what the organisation is doing and why they are doing it, as well as provide updates periodically to employees and all levels of management. Finally, NIOSH suggests that accountability should be built into the implementation of programmes, rewarding success. This should also reflect the commitment of leadership to improving programmes.

Programme evaluation

NIOSH proposes that organisations should develop objectives and relevant measurements, in order to measure, analyse and ultimately evaluate to enable the continual improvement of programmes ^[16]. This framework also suggests that organisations should learn from experience and modify or adjust programmes based on these measured results.

Common elements across models

The following section aims to outline some of the common elements observed across the examined models for healthy organisations. The campaigns by EU-OSHA and ILO are examples of how these common elements are further applied into practice.

Worker participation and involvement: Across all of the discussed models the active involvement and participation of workers was highlighted as a central and defining component of healthy organisations.

Management commitment, engagement and leadership: The active commitment and leadership is highlighted, in the previously discussed models, is viewed as of vital importance in driving the implemented interventions and aiding defining a positive organisational culture. They highlight the central importance of key senior personal within an organisation setting an example, as well as being able to communicate the purpose and reason behind good practice.

Organisational culture: A healthy organisation is defined and sustained by a positive organisational culture that values the importance of safe and health working conditions, but also sees the workplace as a forum in which to promote human potential and growth.

The importance of addressing and managing both the physical and psychosocial working environment: Many of the models highlight the importance of addressing and managing risks that relate to both the physical and psychosocial working environment.

An on-going process of continuous development. In addition all the models outlined and discussed highlighted that creating a healthy organisation is an on-going process that organisations should strive to continually evaluate and improve upon, rather than merely striving to avoid poor organisational health.

Concluding comments

There is a strong connection between the health and well-being of people and their work environments. When people feel valued, respected and satisfied in their jobs and work in safe, healthy environments, they are more likely to be more productive and committed to their work. Therefore, it is clear that the development and cultivation of healthy organisations is something that everyone can benefit from: employees, employers, families, communities and governments.