What is Total Worker Health (TWH)?

In recent years, the field of safety has evolved from its traditional focus on preventing workplace injuries to a broader focus on protecting employee health and well-being, including their psychological safety. *The Total Worker Health® (TWH) initiative by National Institute of Occupational Safety and Health (NIOSH) has emerged as a powerful framework for driving new research and sharing best practices to help employers take a more integrated and effective approach to safety management.

In what follows, we’ll unpack the concept of THW, share some of the key takeaways of the principle and identify some of the key benefits for your business and your employees.

The History of Total Worker Health

First, let’s briefly review the history of the TWH initiative.

The origins of TWH can be traced back nearly two decades ago to a US Department of Health and Human Services (HHS) initiative called “Steps to a Healthier US.” NIOSH applied the basic concept to occupational safety, and in 2004 they sponsored a symposium titled Steps to a Healthier US Workforce to bring together current knowledge and experience about how to not just prevent injuries, but also actively promote health.

NIOSH used feedback from stakeholders at that symposium to develop the “WorkLife” Initiative in 2005, to address workplace safety in a more comprehensive way, taking into consideration traditional occupational safety risks alongside an analysis of how work is organized and its effect on employee behaviors. In 2011, NIOSH changed the name of the initiative from “WorkLife” to Total Worker Health.

Since then, NIOSH has continued to seek input from industry experts and publish additional research, using and expanding upon TWH. For example, NIOSH published a research compendium documenting the growing body of evidence, which shows that integrating occupational safety and health programs into other workplace policies and programs leads to better safety performance.

Elements of Total Worker Health

OK then, what’s actually involved in a TWH framework?

Because TWH is about having a comprehensive focus on all facets of work, there are many different issues that employers need to focus on to get it right. A useful list of those issues is available in this NIOSH-produced document. Let’s focus on some of those issues here.

Prevention and Control of Hazards and Exposures: This is the area that most directly connects TWH to traditional safety management approaches, because it’s really about identification and control of workplace hazards, like exposure to chemicals, biological agents, and physical agents. This also includes ergonomic hazards from poorly designed workstations—in both office and industrial settings. And TWH reflects the growing consensus of safety professionals by addressing the category of psychosocial risks, which are connected to the previous categories; employee awareness of workplace safety risks can contribute to anxiety, which itself increases the probability of injuries.

Built Environment Supports: This category includes considerations of whether the work environment built around employees contributes to their well-being. Are the bathrooms functional, well-maintained and clean? Are all occupied areas well-lit? Are there private nursing/lactation areas available for employees who need them?

Compensation and Benefits: It’s fair to say that for as long as there has been paid labor, there have been employers who’ve given short thrift to these benefits, and certainly many who’ve ignored the connection between these kinds of general equity issues and employee health and well-being. Consider these questions for a moment: Do workers receive fair, market-competitive compensation? Is hard work and achievement rewarded, or is the employee review process structured to minimalize achievement in order to minimalize payroll increases? Is there a promotion of a healthy work-life balance, with paid parental leave policies for all parents, and encouragement of employees to take their paid time off (PTO) without interruptions?

Healthy Leadership: This area has to do with the relationship between supervisors and their direct reports, as well as the contributions of executive leaders to creating a strong safety culture and demonstrating a commitment to the physical and psychological safety of all workers. For example, are supervisors supportive, and do they provide their employees with clear expectations and career paths?

Organization of Work: We can see how this category is connected to others, such as identification of hazards. For instance, one important consideration about the organization of work is whether employees have the appropriate resources to do their job in a way that protects their physical and mental health. Ergonomically designed workstations would be relevant here, as is the right allocation of material handling equipment to avoid strains or injuries from dropped objects. Of course, another important factor here is whether enough money is set aside to fund these resources.

Policies: This is where we look at whether the company has the policies needed to provide a safe work environment, and whether those policies are effective. For example, are there clear anti-harassment and anti-discrimination policies? Does the company provide good training on these policies, and uniformly enforce them organization-wide—even, or especially, for executives and long-term employees?

Work Arrangements: A TWH approach requires commitment to the safety of all workers— contracted and temporary workers, in-person workers and remote workers. That means, as one example, that organizations will need to pay attention to the nuances of multi-employer scenarios. They’ll need to work with other employers involved at a worksite to ensure that all employees receive the information and access to equipment needed to work safely

It’s important to realize that all components of TWH are works in progress, and they will continue to evolve as new research comes in and as the nature of work itself changes. That’s why TWH is tightly connected to the perspective of another NIOSH initiative, The Future of Work. It’s also an important part of the wider framework of Environmental, Social and Governance (ESG).

Benefits of a Total Worker Health Approach

Research shows that a TWH approach actually pays dividends in many different ways. Let’s look at how they benefit workers and employers.

Benefits for Workers: The primary benefits of TWH are for workers, as intended. The more integrated safety management approach of TWH targets all aspects of work and working conditions to address the full spectrum of risks affecting employee physical safety and mental well-being. That, in turn, will mean a reduction in rates of occupational injuries and illnesses, and an increased feeling of psychological safety.

Benefits for Employers: One of the obvious benefits of TWH for employers is that it helps them avoid the “bad stuff,” like injuries and illness and their significant associated costs. But it’s not just about avoiding the downsides for the business, TWH offers substantial benefits for the employer. According to a 2016 journal article, employers self-report that focusing on TWH helps them “accrue competitive advantages related to recruitment, retention, employee satisfaction, community engagement and reputation, and sustainable workforce culture.”

How Do I Get Started?

Now that we know more about what TWH is and its benefits, let’s talk about how you can get started developing your own TWH initiative.

Build a Task Force: The first step is to start building an internal case for your TWH initiatives. You’ll obviously need executive-level support to assure that you’re getting strong commitment. But you’ll also need the engagement of all workers across all departments, including temporary and contracted workers. This helps to get the diversity of insights you’ll need to assess and identify all risks. Get representatives of Human Resources involved to review company policies and help identify where changes, or entirely new programs, may be needed to promote physical and mental health. Sharing information about the documented effectiveness of TWH from NIOSH’s TWH page will help build your case.

Comprehensively Identify Risks: With the right stakeholders lined up, you’re now ready to begin the process of assessing risks. And remember, because this is TWH, you need to look deep and wide. Make sure you’re assessing ergonomics risks, of both office and plant floor workers. A software solution like VelocityEHS Ergonomics can help you, with powerful artificial intelligence (AI) to assess employee physical motions during job tasks and identify potential risks. You should also take a close look at the way work is organized, reviewing shift lengths, physical work environments, and availability of paid leave and other benefits.

Mitigate Existing Risks: Once you’ve identified risks, the next step is to mitigate them to reduce residual risks to acceptable levels. Remember the hierarchy of controls in this process, and that the most effective control will always be elimination or substitution, when feasible. If elimination or substitution alone can’t reduce risks enough, remember that any engineering, administrative or personal protective equipment (PPE) will only be effective to the degree that employees receive appropriate training on their use. Also remember that if your task force identifies risks stemming from corporate policies, revisiting and revising those policies will need to be part of your mitigation strategy.

Prevent Future Risks in Design Phase: A major sign of attaining maturity in your TWH approach is that you can chart a shift from a reactive response to safety incidents to a proactive focus on prevention. Of course, good records of your safety incidents, including determined root causes, will be crucial to help you see the right patterns, and gain insights that will help you eliminate or reduce risks in the design phase going forward. This is a central principle of NIOSH’s Prevention through Design initiative, which should influence all future design projects, whether for new buildings, work stations, structures, or processes. For example, you can design future workstations so that employees won’t need to bend to pick up tools or parts, which therefore eliminates a potential source of strain long before the work of building the station ever begins.

Share and Assess Progress: This is one of the most important steps, so that you can do more of what’s working and less of what’s not. Your success in this step will be contingent upon having established an effective task force, with the full engagement of both task force members and your entire workforce. Your ability to share successes, and talk honestly about failures and corrective actions, will go a long way toward building an effective TWH program that is grounded in strong employee engagement.

Looking for More Information on TWH?

You’re in luck! Register for our upcoming virtual conference for a series of presentations by our in-house subject matter experts about how implement TWH initiatives and use them to improve your safety performance. Register for the conference at the link below!

Total Worker Health^®: What You Need to Know Now

*Total Worker Health® is a registered trademark of the U.S. Department of Health and Human Services (HHS). Use of this Mark by VelocityEHS does not imply endorsement by HHS, the Centers for Disease Control and Prevention, or the National Institute for Occupational Safety and Health of any particular product, service or enterprise. The views expressed in written conference materials and by the speakers do not necessarily reflect the official policies of the Department of Health and Human Services nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Let VelocityEHS Help!

VelocityEHS understands that effective safety management needs to be integrated with the principles of TWH, and modern EHS professionals need the tools to be proactive rather than reactive. That’s why our industrial ergonomics solution uses powerful AI capabilities to give you the actionable insights about risks you need to prevent strains and other musculoskeletal disorders (MSDs). And it’s why our entire platform is built to be intuitive and accessible, so you can engage your workforce, share responsibility for key safety tasks and get the visibility of data you need for better decision making.

As always, please feel free to contact us anytime to learn more about how we can help you become safer and more sustainable.