the state of the art in workplace audits with thomas golaszewski

HEcheck: A Workplace

Health Environment Assessment

Provide a rationale for organizational assessment and intervention

Review the Heart Check odyssey Introduce the new organizational

assessment: HEcheck

Demonstrate HEcheck assessment and reporting capabilities

Discuss the future of organizational assessments

Are systems-based models Explain behavior as the interrelationship of

organisms and their environments

*Salis & Owen, Ecological Models of Health Behavior, In:

Glanz et al, Health Behavior & Health Education, 2002.

Adapted from: http://www.carbc.ca/HelpingCommunities.aspx

“People will change behavior to reflect their environments. Therefore, if you want healthy people, simply create healthy environments.”

Thomas Golaszewski

Grew out of NYS Department of Health’s “Healthy Heart Program” – Mid 1990s

Application of Social Ecology principles

Research Question: How do you create healthy workplace environments?

“You can’t manage IT unless you can measure IT.”

Peter Drucker, Ph.D. (?)

Assessment for organizational support for employee heart health (structure): policies, services and facilities; and program administration

226 items scored as a dichotomy: 0 or +1 Contains sections on: organizational

foundations, administrative support, tobacco, nutrition, physical activity, stress, screening

-20

0

20

40

60

80

100

120

140

160

180

200

Smoking Nutrition Phys Act Screen Adm Sup Total

Experimental

Control

Golaszewski et al. (1998). An Organization-based Intervention to Improve Support for Employee Heart, Am J Health Promotion.

$2,098

$4,530

$5,813

$7,123

$4,401

$3,216

$1,550

$2,667

$3,364

$4,718

$3,069

$2,480

$1,351 $2,110

$2,912

$3,894

$2,605 $2,200

$1,122$1,523 $2,081

$2,941

$1,851 $1,641

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

19-34 35-44 45-54 55-64 65-74 75+

Costs Associated with Risks Medical Paid Amount x Age x Risk

Low Risk

Medium Risk

High Risk

Non - - Participant

Edington. AJHP. 15(5):341-349, 2001

THE HEART CHECK HEALTH PROMOTION MATRIX December 2004

Organizational Foundations: This section describes compensation and human resource management elements that indirectly support employee health. Although very

important, they are not usually under the auspices of the health promotion agenda and are therefore listed separately. 9.1.1, 9.1.2, 9.1.3, 9.2.1, 9.2.2, 9.2.3, 9.3.1, 9.3.2, 9.4.1, 9.4.2, 9.5.1, 9.6.1, 9.7.1, 9.7.2, 9.7.3, 9.7.4, 9.8.1, 9.8.2

Smoking

Nutrition

Physical Activity

Stress

Screening

Administrative

Support

Implementation Level

8.1 8.2 8.6.1 8.11.1

8.1.1 8.6.3 8.11.2

8.1.2 8.5 8.6.4

8.1.3 8.5.3 8.6.5

8.1.4 8.5.4 8.6.6

8.1.5 8.5.5 8.6.7

8.5.6 8.6.8

1. Start-up: Structural development, “must do”

beginning activities, no service

delivery.

3.1.1a 3.4.1

3.1.1b 3.5.1

3.1.1c

3.1.2

3.1.3

3.1.4

4.1.1 4.5.1

4.1.2 4.5.2

4.2.1

4.2.2

4.2.3

5.3.1 5.7

5.3.3

5.3.4 5.8

5.3.6

6.2.2 6.7.1

6.7.2

6.5 6.7.3

6.5.1

6.5.2

6.5.3

8.1.7

8.9

8.10.1

2. Policy/Environment

Enhancement: Easy policy changes or logical

continuations of the above. Sets up

service delivery.

3.2.1

3.3.11

3.3.1

3.3.4

3.3.6

4.1.3 4.4.1

4.4.2

4.2.4 4.4.3

4.4.4

4.3.1 4.4.6

4.3.2 4.4.10

4.3.4

4.3.6 4.6.1

4.3.10

5.4.1 5.9.1 5.10

5.4.2

5.4.4 5.11

5.4.5 5.11.1

5.4.9 5.11.2

6.3.1 6.4

6.3.2

6.3.4 6.8

6.3.6

6.3.10

7.1 7.4

7.1.1 7.4.1

7.1.3 7.4.4

7.6.1

8.7.1

8.8.1

8.12

3. Beginning Service Delivery: Information and awareness building

activities, relatively inexpensive

programming.

3.3.2 3.3.9

3.3.3 3.3.10

3.3.5 3.3.12

3.3.7

3.3.8

3.3.9

3.3.8

3.3.9

4.3.3 4.4.5

4.3.5 4.4.7

4.3.7 4.4.8

4.3.8 4.4.9

4.3.9 4.4.11

4.3.11

5.4.3 5.5 5.6

5.4.6 5.5.1 5.6.1

5.4.7 5.5.2 5.6.2

5.4.8 5.5.3 5.6.3

5.4.10 5.5.4 5.6.4

5.5.5 5.6.5

5.6.6

5.6.7

6.1.1 6.3.3

6.1.2 6.3.5

6.1.3 6.3.7

6.1.4 6.3.8

6.3.9

6.2.1 6.3.11

7.1.2 7.2 7.3

7.1.4 7.2.1 7.3.1

7.1.5 7.2.2 7.3.2

7.2.3 7.3.3

7.4.2 7.2.4 7.3.4

7.4.3 7.2.5 7.3.5

8.3 8.7.2

8.7.4

8.4

8.4.1 8.8.2

8.4.2 8.8.3

8.4.3

4. Advanced Service Delivery: More expensive and intrusive than the

above, broadened service delivery.

3.2.2

5.1 5.2 5.3.2

5.1.1 5.2.1 5.3.5

5.1.2 5.2.2

5.1.3 5.2.3

5.1.4 5.2.4 5.9.2

5.2.5

5.2.6

6.6

6.6.1

6.6.2

6.6.3

6.6.4

7.5

7.5.1

7.5.2

7.5.3

8.1.6 8.7.3 813.1

8.13.2

8.5.1 8.10.2 8.13.3

8.5.2

8.6.2

5. Institutionalization: Advanced policy development,

relatively expensive, high capital

costs, long term cultural change.

THE HEART CHECK HEALTH PROMOTION MATRIX November 2006

Organizational Foundations: This section describes compensation and human resource management elements that indirectly support employee health. Although very

important, they are not usually under the auspices of the health promotion agenda and are therefore listed separately. 9.1.1, 9.1.2, 9.1.3, 9.2.1, 9.2.2, 9.2.3, 9.3.1, 9.3.2, 9.4.1, 9.4.2, 9.5.1, 9.6.1, 9.7.1, 9.7.2, 9.7.3, 9.7.4, 9.8.1, 9.8.2

Smoking

Nutrition

Physical Activity

Stress

Screening

Administrative

Support

Implementation Level

8.1 8.2 8.6.1 8.11.1

8.1.1 8.6.3 8.11.2

8.1.2 8.5 8.6.4

8.1.3 8.5.3 8.6.5

8.1.4 8.5.4 8.6.6

8.1.5 8.5.5 8.6.7

8.5.6 8.6.8

1. Start-up: Structural development, “must do”

beginning activities, no service

delivery.

3.1.1a 3.4.1

3.1.1b 3.5.1

3.1.1c

3.1.2

3.1.3

3.1.4

4.1.1 4.5.1

4.1.2 4.5.2

4.2.1

4.2.2

4.2.3

5.3.1 5.7

5.3.3

5.3.4 5.8

5.3.6

6.2.2 6.7.1

6.7.2

6.5 6.7.3

6.5.1

6.5.2

6.5.3

8.1.7

8.9

8.10.1

2. Policy/Environment

Enhancement: Easy policy changes or logical

continuations of the above. Sets up

service delivery.

3.2.1 3.3.11

3.3.1

3.34

3.36

4.1.3 4.4.1

4.4.2

4.2.4 4.4.3

4.4.4

4.3.1 4.4.6

4.3.2 4.4.10

4.3.4

4.3.6 4.6.1

4.3.10

5.4.1 5.9.1 5.10

5.4.2

5.4.4 5.11

5.4.5 5.11.1

5.4.9 5.11.2

6.3.1 6.4

6.3.2

6.3.4 6.8

6.3.6

6.3.10

7.1 7.4

7.1.1 7.4.1

7.1.3 7.4.4

7.6.1

8.7.1

8.8.1

8.12

3. Beginning Service Delivery: Information and awareness building

activities, relatively inexpensive

programming.

3.3.2 3.3.9

3.3.3 3.3.10

3.3.5 3.3.12

3.3.7

3.3.8

4.3.3 4.4.5

4.3.5 4.4.7

4.3.7 4.4.8

4.3.8 4.4.9

4.3.9 4.4.11

4.3.11

5.4.3 5.5 5.6

5.4.6 5.5.1 5.6.1

5.4.7 5.5.2 5.6.2

5.4.8 5.5.3 5.6.3

5.4.10 5.5.4 5.6.4

5.5.5 5.6.5

5.6.6

5.6.7

6.1.1 6.3.3

6.1.2 6.3.5

6.1.3 6.3.7

6.1.4 6.3.8

6.3.9

6.2.1 6.3.11

7.1.2 7.2 7.3

7.1.4 7.2.1 7.3.1

7.1.5 7.2.2 7.3.2

7.2.3 7.3.3

7.4.2 7.2.4 7.3.4

7.4.3 7.2.5 7.3.5

8.3 8.7.2

8.7.4

8.4

8.4.1 8.8.2

8.4.2 8.8.3

8.4.3

4. Advanced Service Delivery: More expensive and intrusive than the

above, broadened service delivery.

3.2.2

5.1 5.2 5.3.2

5.1.1 5.2.1 5.3.5

5.1.2 5.2.2

5.1.3 5.2.3

5.1.4 5.2.4 5.9.2

5.2.5

5.2.6

6.6

6.6.1

6.6.2

6.6.3

6.6.4

7.5

7.5.1

7.5.2

7.5.3

8.1.6 8.7.3 813.1

8.13.2

8.5.1 8.10.2 8.13.3

8.5.2

8.6.2

5. Institutionalization: Advanced policy development,

relatively expensive, high capital

costs, long term cultural change.

Risk 2005 2007 Difference

Safety Belt Use 9.0% 5.4% -3.6%*

Medication for Relaxation 27.1% 23.9% -3.2%

Physical Inactivity 18.5% 15.9% -2.6%

Smoking 9.8% 7.6% -2.2%

Illness Days 30.1% 28.3% -1.8%

Life Dissatisfaction 25.2% 23.9% -1.3%

Perceived Health 17.6% 16.60% -1.0%

Health Age Index 1.9% 0.9% -1.0%

Disease 13.9% 13.1% -0.8%

Alcohol 2.0% 1.3% -0.7%

**Also a significant decrease in recorded absenteeism.

Organizational health support (OHS) can be measured reliably and accurately.

Relationships exist between OHS measures and employee health risks, health culture, absenteeism, and selected health care costs.

OHS can be improved relatively easily and cost effectively.

Employee health risk profiles stabilize with organization-focused intervention.

Most OHS variables remain following intervention.

OHS tools can be integrated within a comprehensive worksite health promotion intervention

Contextual Work Features (Organizational Leadership, industry type,)

(management style, profitability, etc.)

Worksite Worksite Structure Culture

Golaszewski et al. (2008). Working Together to Create Supportive Environments

in Worksite Health Promotion, The Art of Health Promotion.

Recommendations… Develop new tools based on the latest standards

of excellence in WHP Consider alternate item construction Add organizational health culture Refine automated systems accessible on the

Internet Develop detailed summary reports

Golaszewski, in:Pronk (Ed.). 2009. ACSM’s Worksite Health

Handbook.

An assessment process of the workplace’s HEALTH ENVIRONMENT that supports employee health.

Online capability 3 dimensions, 9 sections, 47 constructs and

227 items (variable weights) Within dimension/section/construct

scoring And more…

3. Medical Management

2. Risk Management

1. Foundations

Medical Management

Psychosocial

Tobacco Control

Nutrition

Physical Activity

Screening

Culture Change

Commitment

Human Resources Management

Assessment Awareness Services Structural Supports Policy Supports

To the online HEcheck…

Expand research activity at the company-level Establish norms for geographic region, health

plan groups, industry type, or other company demographic

Link organizational rewards to high scoring companies, e.g., provide award recognitions, premium discounts or rate “lock ins”