how can leadership and training contribute ... -...

HOW CAN LEADERSHIP AND TRAINING CONTRIBUTE TO

A HEALTH PROMOTING ORGANISATIONAL CULTURE ?

Consol Serra, MD PhD

Occupational Health Service, Parc de Salut MAR

CiSAL - Centre for Research in Occupational Health, University Pompeu Fabra

Workplace health promotion Group, Catalan Network HPH

Barcelona, Spain

Barcelona, 23-25 April 2014

http://www.parcdesalutmar.cat/mar/Parc_Salut_MAR.html

The changing nature of world of work: positive effects of work on health…

Van der Noordt M, et al. Health effects of employment: a systematic review of prospective studies. Occup Environ Med. 2014 Feb 20. [Epub ahead of print]

The longer you work, the longer you live Change of paradigm of occupational health:

maintaining people at work!

Butterworth p, et al. The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey. Occup Environ Med. 2011;68:806-12

Consol Serra. How can leadership and training contribute to a health promoting organisational culture?. HPH, Barcelona 2014


Source: Shain M, Kramer DM. Occup Environ Med 2004;61:643–648

The costs of an unhealthy workplace


Health, life styles and working conditions of physicians in Catalonia, 2007

Support supervisor Participation Control

Psychological demands

Support from peers

(men)

(women)

Psychosocial risk factors


Environmental and individual factors

• Potential role of everyday stress in dietary, eating, and physical activity behaviors.

• The association of perceived stress and these behaviors is likely greater in people who have higher levels of stress.

Perceived stress, behaviour, and BMI among adults participating in a worksite obesity prevention program, Seattle, 2005-2007.

Barrington WE, et al. Prev Chronic Dis. 2012;9:E152.


• First philosophy, workplace as a venue (opportunity):

individual behaviour and responsibility

Examples: fitness, stress management, smoking cessation, back care, weight reduction/nutrition, medication.

Health promotion in the workplace

• Second philosophy, workplace as an influence on health in its own: environment and individual

The organisation and design of work in both its physical and

psychosocial dimensions.


Luxembourg declaration,1997.




Forces acting on health and productivity in the workplace, general picture :

What EMPLOYEES bring

with them to the workplace

in terms of personal

resources, health practices,

beliefs, attitudes, values,

and hereditary endowment.

What the WORKPLACE

does to employees once

they are there in terms

of organisation of work

in both the physical and

psychosocial sense.

interaction


Environmental and individual factors

Sorensen G, et al. Cancer Causes and Control 13: 493–502, 2002

HP/OHS final HP final OR p

n 365 319

Smoking quit rate 11.8 5.9 2.13 0.04


• Improving working conditions

• Managing individual cases

Impact on disability and unemployment

Promoting health at work: what does it mean ?

• Promoting healthy lifestyles


Promoting health at work: what do we need ?

• Resources, investments

• Expertise, competencies

• Legal frame and specific legislation

• ORGANISATIONAL CULTURE: involvement at all levels top management (chief executive, directors)

line managers (supervisors, heads, etc.)

workers and their representatives

occupational health & safety experts

others: technology, finances, HR, kitchen, etc.

The product of individual and group values, attitudes, perceptions, competencies

and patterns of behaviour that determine the commitment to, and the style and

proficiency of, an organisation’s health promotion climate (adapted from Flin 2006).

OR (95% CI)

• Managerial support 0.56 (0.38 - 0.81)

• Feedback and training 0.42 (0.21 - 0.82)

Gershon et al. Am J Infect Control 2000

Table 6. Multiple logistical regression of safety climate sub-factors with exposure incidents as the outcome.

Safety climate and compliance with universal precautions




• Management and leadership

• Training to build capacity

Managers

and

Employees

Self-managed work teams



MANAGEMENT INVOLVEMENT IN HP

Programme design prerequisites are necessary but not sufficient, it needs:

• Management support

Ensuring that employees understand and feel employer’s commitment to the protection and promotion of employees’ wellbeing.

Managers give employees possibilities for different health promotion activities.

• Supportive management climate:

Organising work in ways that promote rather than defeat health and safety.

Work is managed in a way that is health promoting for employees.

Health promoting LEADERSHIP


Employee engagement and NHS performance Michael A West and Jeremy F Dawson, 2012



Review on leadership and management in the aged care sector

Jeon H-E, et al. Australasian Journal on Ageing. 2010; 29:54–60

• Leadership is a hallmark of effective management.

• Leadership skills can be developed through targeted management training and mentorship.

• Effective leadership is integral to workforce retention and quality care delivery.


Health-Promoting Leadership

Andrea Eriksson. Doctoral thesis, Nordic School of Public Health. Sweden, 2011

• Management = formal systems and concrete issues (goals setting, plans, cultural values, common assumptions)

• Leadership = unknown, informal systems, humans relations and organising people, changes and new systems, values, culture. Transformational, transactional.


Occup Environ Med 2009; 66: 51-55.


Good leadership:

• Support

• Communication

• Negotiation

• Empowerment

• Participation

• Team unity


... and, what is leadership in health promotion ?

• Health-promoting leadership concerns with creating a culture for health-promoting workplaces and values that inspire and motivate employees to participate in such development.

• It means organising HP activities, supportive leadership style and developing a HP workplace.

• It is a critical part of organisational capacity for HP, including managerial knowledge and skills, organisational policies and structures.

• Requires support to managers, training, focused programs and action plans.

• Associated to positive effects on employees health, satisfaction and productivity.


Source: Eriksson A. Health-Promoting Leadership. Doctoral thesis, Nordic School of Public Health, Sweden 2011.


Review of the knowledge base on healthy worksite culture

Aldana S, et al. J Occup Environ Med. 2010; 54:414-9.

Improvement in employee health risk and level of leadership support



Leading by example

1. Take responsibility 2. Be truthful 3. Be courageous 4. Acknowledge failure 5. Be persistent 6. Create solutions 7. Listen 8. Delegate liberally 9. Take care of yourself 10. Roll up your sleeves

Assessing management support for worksite health promotion:

Leading by example (LBE) scale developed by Partnership for Prevention; modified and validated by Della LJ, et al. AJPH 2008



Della LJ, et al. Am J Health Promot. 2010;25:138-146


• Moderate-intensity intervention: access to healthy food and physical activities

• High-intensity intervention: + management/leadership support to increase health promotion climate (communication, leadership encouragement (goals, reward, training)

(Estimated means across three factors of the LBE instrument)

Intervention intensity

Moderate High

1. Awareness of economics of health and productivity 3.01 3.14

2. Worksite support for health promotion 3.24 3.43

3. Leadership support for health promotion 3.47 3.57


The process of organisational culture

Source: European Agency for Safety and Health at Work, 2011. Occupational Safety and Health culture assessment - A review of main approaches and selected tools.

The HSE culture stepladder.


TRAINING to promote health at work

Source: Conceptual model of workplace training interventions for primary prevention in OHS. Robson LS et al. 2012

• Training has immediate effects on knowledge, attitudes, behaviour.

• These outcomes eventually affect behaviours and hazards, which in turn impact outcomes at the longer term (injuries, illnesses).

• Determined by training, trainees and workplace environment.


TRAINING to promote health at work

A controlled trial of an educational program to prevent low back injuries

Daltroy LH, et al. The New England Journal of Medicine, 1997


Training: scientific evidence from systematic reviews

Effectiveness of training on health and other outcomes

• Cohen A, et al. Assessing occupational health and training. NIOSH, 1998.

• Burke MJ, et al. Relative effectiveness of worker safety and health training methods. Am J Public Health, 2006.

• Robson LS, et al. Effectiveness of occupational health and safety training. IWH, 2012.

MSK and ergonomics:

• Brewer S, et al. Workplace interventions to prevent MSK and visual symptoms and disorders in computer users. J Occup Rehab, 2006.

• Brewer S, et al. Injury/illness prevention and loss control programs. IWH, 2007.

• Martimo KP, et al. Training and lifting equipment for preventing back pain in lifting and handling. Br Med J, 2008.

• Kennedy CA, et al. Role of OH&S interventions in the prevention of upper extremity MSK symptoms, signs, disorders, injuries, claims and lost time. J Occup Rehab, 2010.

A systematic review of the effectiveness of occupational health and safety training

Lynda S Robson, Carol M Stephenson, Paul A Shulte, Benjamin C Amick III, et al.

Institute of Work and Health, Toronto (Canada). Review team: Canada and USA. Included studies = 22


Source: Scand J Work Environ Health. 2012; 38:193-208


• Workplace education and training programs is recommended.

• Positive impact on the OHS behaviours of workers.

• However, no impact on health was shown (reducing injuries, symptoms).

• Not enough high quality studies to make recommendations about the nature or type of training, such as the level of engagement, computer versus lecture training or the number of sessions.

Robson LS, et al. Institute of Work and Health, Toronto (Canada), 2012

Source: www. http://www.cdc.gov/niosh/docs/2010-127/pdfs/2010-127.pdf


CONCLUSIONS

• Hospitals and health services are health producing companies and should contribute to the benefits on health of having a job, to maintain health care workers at work and reduce turnover.

• Organisational culture to promote health at work is essential also in the healthcare sector.

• Good managers and leadership, and good and appropriately focused training are key elements to accomplish that goal.

LEADERSHIP manager

TRAINING employee

CULTURE organisation


MOLTES GRÀCIES

THANK YOU VERY MUCH

how can leadership and training contribute ... -...

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