Articulo 1 Jessica

ACOEM GUIDANCE
Integrating Health and Safety in the Workplace

How Closely Aligning Health and Safety Strategies Can Yield
Measurable Benefits
Ronald R. Loeppke, MD, MPH, FACOEM, Todd Hohn, CSP, Catherine Baase, MD, FACOEM, FAAFP,
William B. Bunn, MD, JD, MPH, FACOEM, Wayne N. Burton, MD, FACOEM, Barry S. Eisenberg, CAE,
Trish Ennis, CSP, ARM, CRIS, Raymond Fabius, MD, CPE, DFACPE, R. Jack Hawkins, CSP,
T. Warner Hudson, MD, FACOEM, FAAFP, Pamela A. Hymel, MD, MPH, FACOEM, Doris Konicki, MHS,
Paul Larson, MS, Robert K. McLellan, MD, MPH, FACOEM, FAAFP,
Mark A. Roberts, MD, PhD, MPH, FACOEM, Cary Usrey, Joseph A. Wallace, CSP, RRE,
Charles M. Yarborough, MD, MPH, FACOEM, and Justina Siuba, MPH
work for advancing the concept with a system of Coinciding with these advances in
Objective: To better understand how integrating
health and safety metrics, modeled after the Dow safety was the rise of a workplace wellness
health and safety strategies in the workplace has
Jones Sustainability Index. Methods: Seven lead- movement in the United States, driven in
evolved and establish a replicable, scalable frame-
ing national and international programs aimed at part by rising health care costs.2 As costs in-
From Chief Health Officer (Dr Baase), The Dow creating a culture of health and safety in the work- creased, employers began to introduce “work-
Chemical Company, Midland, MI; Northwestern place were compared and contrasted. Results: A site health promotion” programs on a large
University and University of Illinois at Chicago, list of forty variables was selected, making it clear scale in an effort to keep their employees
School of Public Health (Dr Bunn), Hilton Head, there is a wide variety of approaches to integration healthier and thus reduce total health-related
SC; Chief Medical Officer (Dr Burton), American
Express, Chicago; Executive Director (Mr Eisen- of health and safety in the workplace. Conclusion: costs (medical/pharmacy costs and absen-
berg), American College of Occupational and En- Depending on how well developed the culture of teeism/presenteeism costs).
vironmental Medicine, Elk Grove Village, IL; health and safety is within a company, there are Early workplace wellness programs
VP Denver Risk Control Manager, Risk Control unique routes to operationalize and institutionalize consisted of health screenings, smoking ces-
and Claim Advocacy Practice (Ms Ennis), Willis
Group, Wheat Ridge, CO; Co-founder & Presi- the integration of health and safety strategies to sation, weight-loss education, and on-site ex-
dent (Dr Fabius), HealthNEXT, Newtown Square, achieve measurable benefits to enhance the overall ercise offerings, including corporate fitness
PA; Director, Environmental Health & Safety health and well-being of workers, their families, centers. Over time, these programs evolved
(Mr Hawkins), Time Warner Cable, Inc., Char- and the community. into much more sophisticated efforts, which
lotte, NC; Global Director - Workplace Health
and Safety (Mr Hohn), Underwriters Laborato- today include the use of health risk appraisals
ries, Inc.; Medical Director, Occupational and (HRAs) and biometric monitoring; programs
Employee Health (Dr Hudson), UCLA Health In recent decades, US employers have made for the management of chronic health con-
System and Campus, Los Angeles; Chief Med- significant progress in addressing issues of ditions, such as diabetes, behavior modi-
ical Officer (Dr Hymel), Walt Disney Parks and
Resorts, Anaheim, CA; Director Corporate Re- health and safety in the workplace. Since fication, and large-scale population health
lations (Ms Konicki), ACOEM, Chicago; Paul 1970, workplace fatalities have been reduced strategies based on clinical data. Many large
Larson Communications (Mr Larson), Evanston, by more than 65% and injury and illness rates employers have even established medical
IL; Vice-Chairman (Dr Loeppke), US Preventive have declined by 67%, according to the Oc- clinics and pharmacies on site. Increasingly,
Medicine, Inc., Brentwood, TN; Associate Pro-
fessor (Dr McLellan), Medicine, Community and cupational Safety and Health Administration employers use these programs and other
Family Medicine, and The Dartmouth Institute (OSHA).1 Worker deaths have been reduced strategies to integrate health broadly into cor-
for Health Policy and Clinical Practice, Geisel from approximately 38 per day in 1970 to 12 porate practices in an effort to establish what
School of Medicine at Dartmouth, Lebanon, NH; per day in 2012. is often referred to as a “culture of health”
Principal Scientist/Director Center for Occupa-
tional & Environmental Health (Dr Roberts), Ex- During this time, major safety im- alongside a culture of safety.
ponent, Chicago, IL; Process Improvement Leader provements have been made through the Over the course of many decades,
(Mr Usrey), Predictive Solutions, Oakdale, PA; use of risk assessment, medical surveillance these two workplace activities—safety and
Risk Control Director - Nashville & New Or- examinations, safety training, improved pro- wellness—have evolved in tandem, but they
leans (Mr Wallace), CNA Insurance, Old Hickory,
TN; Director of Medical Strategies (Dr Yarbor- tective equipment, better mechanical safety have operated mostly independently, with
ough), Lockheed Martin Corporation, Bethesda, engineering and other physical changes in the separate work teams and organizational re-
MD; and Health Educator (Ms Siuba), Department workplace, and a host of other factors. These porting structures.3 Today, they are broadly
of Health and Environmental Control, Columbia, include efforts by labor and management to known as “health protection” (safety) and
SC.
Recommendations from the Summit on Integration of address safety issues more comprehensively, “health promotion” (wellness).
Health and Safety in the Workplace, hosted by the the rise of new governmental agencies Health protection usually encom-
American College of Occupational and Environ- focused on safety, and an increase in re- passes the activities that protect workers from
mental Medicine and Underwriters Laboratories, search and education devoted to safety. The occupational injury and illness—ranging
August 2014.
The authors declare no conflicts of interest. establishment of OSHA and the National from basic safety training and the use of
Address correspondence to: Ronald R. Loeppke, Institute for Occupational Safety and Health protective gear to equipment safety enhance-
MD, FACOEM, Vice-Chairman, US Preventive (NIOSH) in 1970 was also an important ments and improvements to the work environ-
Medicine, Inc., 5166 Remington Dr., Brentwood, factor. Over time, employers adopted safety ment. Health promotion encompasses the ac-
TN 37027-3001 ([email protected]).
Copyright C 2015 by American College of Occupa-
as a company value and built what came to be tivities that maintain or improve the personal
tional and Environmental Medicine known as a “culture of safety” among their health of a workforce—ranging from the use
DOI: 10.1097/JOM.0000000000000467 employees. of health risk assessments and immunizations
JOEM r Volume 57, Number 5, May 2015 585
Copyright © 2015 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited.
Loeppke et al JOEM r Volume 57, Number 5, May 2015
to chronic-disease and catastrophic-illness within these communities—ranging from in- This white paper addresses each of
management. The professionals who work dustrial hygienists and safety engineers to these needs, offering a standardized defini-
within these activity centers include ev- occupational health physicians, nurses, and tion and set of components that should be
erything from safety engineers and in- other practitioners of Occupational and Envi- considered a part of IHS programming, a new
dustrial hygienists to occupational health ronmental Medicine—are seeking new ways measurement tool for integration, based in
nurses and physicians trained in Occupa- to work together and leverage their various part on the concept of the well-known Dow
tional and Environmental Medicine and pre- best practices and long-established health Jones Sustainability Index (DJSI), and a basic
ventive medicine, and they may be housed in and safety guidelines. how to framework for employer teams seek-
various clinical and operational centers in or In the years since the publication of ing to better align health and safety strategies
near workplaces, from occupational health to Workplace Health Protection and Promotion: across silos and better integrate their health
human resources or benefits administration. A New Pathway for a Healthier—and Safer— and safety functions.
In recent years, employers and oth- Workforce, the chorus of voices advancing Taken together, these activities com-
ers in the occupational health community health and safety integration has certainly prise a new way of approaching health pro-
have begun to view the traditionally sepa- grown, but the number of employers actively tection and health promotion in the work-
rated “silos” of health promotion and health exploring this concept remains small. Al- place, which can be called “Integrated Health
protection—or, put more simply, health and though employers have made great strides in and Safety” (IHS). This view uses the term
safety—in a new light, recognizing that their creating separate cultures of health and safety “health” very generally to define various
positive impact in the workplace could be in the United States, only a few innovative employer health-promotion and occupational
magnified by more effectively aligning the employers have led the way and demonstrated medicine activities, just as it uses “safety”
strategies that guide them. that health and safety can be more powerful very generally to define various employer
A growing number of initiatives and if integrated. health-protection activities. The key point
studies, in fact, are embracing the idea that es- is that typical workplaces deploy diverse
tablishing a true culture of health in the work- THE INTEGRATED HEALTH health and safety initiatives—each of which
place is dependent on the integration of health AND SAFETY SUMMIT must be integrated as part of a continuum
protection and health promotion strategies. In an effort to better understand how of well-being for their full potential to be
Leading experts in both the health and safety the environment for integrating health and achieved.
professional communities are building pro- safety in the workplace has changed over It is important to note in this discus-
grams around the concept that health activi- the last several years and to seek new ways sion that the concept of IHS is inclusive of oc-
ties impact safety and safety activities impact of advancing the concept, ACOEM and UL cupational health and safety, but not limited
health. hosted a summit meeting during the sum- to it. The concept is overarching, encompass-
In a 2011 paper titled Workplace mer of 2014 that comprised experts from ing traditional occupational health and safety
Health Protection and Promotion: A New corporate, governmental, not-for-profit, ed- elements, while expanding their impact—
Pathway for a Healthier—and Safer— ucational, and research organizations. through synergy—to a wider spectrum of
Workforce, Hymel, Loeppke, Baase, et al de- Over the course of 2 days, the 21- personal and population health outcomes.
scribed the integration of health protection member group identified several key factors A workplace with a single, cross-divisional
and health promotion as a continuum, in that, if addressed, could help create a more fa- IHS strategy can magnify the effectiveness
which “health promotion interventions con- vorable environment for advancing the prin- of its programs dramatically.
tribute dynamically to improved personal ciples of health and safety integration in the At the societal level, the impact of this
safety in addition to enhancing personal United States: new way of approaching workplace health
health, while occupational safety interven- and safety is profound. As the United States
tions contribute dynamically to improved r Determining why health and safety inte- and the rest of the world face the rising burden
personal health in addition to enhancing per- gration is important and how it should of costs associated with chronic disease and
sonal safety . . . The two factors, personal be defined: A clearer demonstration of the poor health, numerous studies suggest that
health and personal safety—each essential value proposition for health and safety in- comprehensive intervention strategies will
to a productive worker and to a produc- tegration is needed, along with a better def- be required. Evidence confirms that stand-
tive workplace—are effectively combined in inition of the components that make up in- alone, nonintegrated efforts to address these
a symbiotic way that increases their im- tegrated health and safety (IHS) programs. issues will not succeed.5 Cross-discipline
pact on overall health and productivity. The r Formulating what should be measured to and cross-sector initiatives—including the
whole becomes greater than the sum of its evaluate the impact of IHS programs: A integration of health interventions in a way
parts.”4(p695) set of key metrics is needed, which could that links the community (public health), the
Supporters of the health and safety be used to measure the effectiveness of home (primary care), and the workplace (oc-
continuum concept are increasing, and vari- IHS strategies and programs and deter- cupational health and safety)—hold the most
ous integration projects, initiatives, or studies mine their value for employers, investors, promise for success in addressing our grow-
are either under way or in development at or- and policymakers, along with the devel- ing global health issues. To effectively ad-
ganizations such as the American College of opment of a health and safety index that dress our large-scale health issues in the
Occupational and Environmental Medicine could rate a company’s performance in in- United States and the world, the gatekeep-
(ACOEM), Underwriters Laboratories (UL), tegrating programs. ers of health in each sector—the community,
the American Society of Safety Engineers, r Describing how employers can systemat- the home, and the workplace—must work to-
the American Industrial Hygiene Associa- ically develop and implement IHS pro- gether in new ways.
tion, the Centers for Disease Control and Pre- grams: A set of practical, scalable, The widespread adoption of an IHS
vention, and the NIOSH, as well as at lead- comprehensive guidelines is needed for model in the workplace would ensure that this
ing employers, such as The Dow Chemical employers—and specifically, for their vital sector—impacting the health of more
Company, American Express and Navistar, health and safety teams—offering step-by- than 130 million Americans—is well-aligned
and at academic centers, such as Dartmouth- step advice on how to integrate strategic and prepared as the transition to cross-sector
Hitchcock and the University of California health and safety programs across opera- health intervention strategies begins to take
at Los Angeles. Diverse professional voices tional silos. hold in the United States and globally.
586
C 2015 American College of Occupational and Environmental Medicine
JOEM r Volume 57, Number 5, May 2015 Integrating Health and Safety in the Workplace
DEFINING “INTEGRATION”: A r The Healthy Workplace Participatory Pro- Participants in the ACOEM/UL sum-
LOOK AT VARIOUS HEALTH gram from the Center for Promotion and mit concluded that these activities—
Health in the New England Workplace strategies for better aligning and integrating
AND SAFETY APPROACHES IN (CPH-NEW) health and safety efforts across operational
THE WORKPLACE r Let’s Get Started from NIOSH’s Total activity centers and a universally applicable
In Workplace Health Protection and Worker Health program system of health and safety metrics—are the
Promotion: A New Pathway for a Healthier— r Healthy Workplaces from the World Health two components most often missing from
and Safer—Workforce, Hymel et al defined Organization (WHO) guidelines in use today. Both components are
workplace health protection and promo- r Managing Stress from the European Union crucial for the creation of a sustainable cul-
tion as “the strategic and systematic in- (EU) Agency for Safety and Health ture of health in the workplace. The absence
tegration of distinct environmental, health of these two components may keep employers
and safety policies and programs into a Components in all of these guidelines from taking their health and safety programs
continuum of activities that enhances the are aimed at addressing both health and safety to the next level of effectiveness and may be
overall health and well-being of the work- in the workplace, but each approaches the part of the reason more employers have not
force and prevents work-related injuries and task with different tools, different levels of adopted culture-of-health initiatives. A next-
illnesses.”4(p695) The National Institute for emphasis, and somewhat different workplace generation definition of integrated health pro-
Occupational Safety and Health, which re- audiences in mind. Through a process of tection and promotion, then, would build on
cently launched its Total Worker Health ini- comparing and contrasting these seven guide- earlier definitions and add the crucial ele-
tiative in an effort to encourage wider integra- lines, summit participants were able to create ments of universal measurement and align-
tion of health and safety in the workplace, de- a list of 40 variables representing a range of ment of strategies across silos to create IHS,
fines what it calls “total worker health” as “a components that are typically found in IHS which could be defined this way:
strategy integrating occupational safety and programming. Each variable was rated by the Integrated Health and Safety is the
health protection with health promotion to level of emphasis placed on it in the overall strategic and systematic integration of dis-
prevent worker injury and illness and to ad- mix of best practices offered by each of the tinct health and safety programs and policies
vance health and well-being.” Other leaders guidelines to determine trends (see sample into a continuum of organizational, personal,
in the integration movement, including the checklists in Appendix 1). occupational, community, and environmental
Live Well/Work Well program at Dartmouth- By comparing and contrasting the 40 activities that are replicable, measurable, and
Hitchcock and the WorkStrong program at variables identified in these guidelines, it be- integrated across institutional silos, enhanc-
the University of California at Los Angeles, comes clear that there are a wide variety of ing the overall health and well-being of work-
do not offer definitions per se but list key prin- approaches to integration of health and safety ers and their families and preventing work-
ciples that must be in place for integration in the workplace today. For example, advice related injuries and illnesses.
to yield benefits, ranging from the integra- on employee engagement is commonly of- This is certainly not the only defini-
tion of primary care, disease management, fered in all of the leading integration guide- tion that can be applied in an environment
and program sustainability to teamwork and lines, but only three of the five offer strate- that is brimming with integrated concepts,
management accountability. gies for obtaining senior leadership support ranging from NIOSH’s Total Worker Health
In seeking a better understanding of for integration efforts, and these vary in em- initiative to the WHO’s Healthy Workplaces
the elements and definitions most commonly phasis. Although all of the guidelines offer guidelines. But it does begin to place a new
found in IHS programming, participants in strategies for program evaluation, only one emphasis on building health and safety strate-
the 2014 ACOEM/UL summit meeting com- puts a strong emphasis on data management gies that are specifically designed for align-
pared and contrasted seven leading national as a strategic element. Guidelines also vary ment across operational silos in the work-
and international guidelines that are aimed at in the extent to which scientific evidence is place. Summit participants—representing
creating a culture of health in the workplace cited for their recommendations. diverse professional backgrounds and expe-
by focusing on health and safety together A review of the guidelines also sug- rience in health and safety—agreed that one
across operational divisions. These guide- gests that while many share common ele- of the most pressing needs in the workplace
lines were chosen among many existing ap- ments aimed at guiding employers toward is the “how to” of IHS—tools and metrics
proaches because they exemplify tactics for the integrated use of both health and safety to help managers who may intuitively under-
improving workforce health that put a pointed programs in the workplace, specific strate- stand the value of integration but lack the
emphasis on integration and offer both health gies aimed at helping employers unify strate- know-how to accomplish it.
and safety components. By comparing and gies across organizational silos and bring What follows is a proposed framework
contrasting them, a broad overview of cur- disparate teams together operationally for for IHS aimed at this need—a system for con-
rent trends and best practices can be estab- more effective integration are lacking. More- sistent measurability as well as implementa-
lished. This, in turn, can help identify ad- over, a comprehensive and universally ap- tion of replicable, scalable integration strate-
ditional components that may be needed to plicable system of metrics that could be gies that bring together health and safety
achieve the goal of widespread adoption of used to gauge the effectiveness of such pro- teams in the workplace. The framework be-
health and safety integration. grams is not evident. Although the impor- gins with the foundational building block of a
Guidelines compared and contrasted tance of measurement is discussed in var- universally applicable metrics reporting sys-
included: ious guidelines and suggestions for mea- tem that measures the impact and corporate
surement are offered, none provides an value of IHS programs in the workplace.
r SafeWell from the Harvard University overarching, integrated measurement sys-
School of Public Health tem. Also absent is a measurement approach TAKING INTEGRATION TO THE
r The Whole Worker from the Commission that could translate health and safety met-
on Health and Safety and Workers’ Com- rics into business value—that is, a way of
NEXT LEVEL: THE NEED FOR A
pensation (CHSWC) consistently demonstrating how health and NEW SYSTEM OF HEALTH AND
r The Integrated Employee Health model safety programs impact an organization’s SAFETY METRICS
from the National Space and Aeronautics performance, productivity, and marketplace Among the fastest growing disci-
Administration (NASA) success. plines within the occupational health and

C 2015 American College of Occupational and Environmental Medicine 587
safety community over the last decade has tance of prevention within businesses as a dices. Many companies around the world
been health and productivity management, a national strategic imperative.”8 include achieving a listing in the DJSI as
strategic approach to workplace health and Institutionalizing health and safety a corporate goal because it provides pub-
safety that focuses on identifying the total metrics reporting has the potential to set lic validation of their long-term management
impact of employee health on business re- various corporate and financial dynamics in strategies and increases their attractiveness to
sults and reducing impacts on performance motion that would push workplace IHS pro- investors. There is what DJSI administrators
and productivity costs, such as absenteeism gramming into the mainstream of business call “vibrant competition among companies
and presenteeism, through targeted health strategy, according to the authors: for index membership.”10
and safety programming. A growing body Taking into account the global suc-
“It also enables investors and other
of evidence supports health and productiv- cess and impact of the DJSI, and increasing
key stakeholders to consider the health
ity management’s underlying concept—that discussions among workplace health experts
of employees within a business as a
focusing on the health and safety of a work- about the need for standardized, public met-
critical data point for investment deci-
force is good business. Engaging in a com- rics reporting of health and safety data, par-
sion making, due to the dual impact of
prehensive effort to promote wellness, re- ticipants at the ACOEM/UL summit meeting
health on a business (ethical and finan-
duce worker safety risks, and mitigate the in 2014 posed two questions—Could a con-
cial). This latter effect in turn places
complications of chronic illness within work- sistent, replicable, public metrics reporting
increased pressure on businesses to
place populations can produce remarkable ef- system similar to DJSI be created to assess
consider it as a critical component of
fects on health care costs, productivity, and the business value of health and safety for in-
business strategy. Finally, it also en-
performance.6 vestors? Would creation of such a system help
ables organizations to measure, man-
More recently, studies have begun propel faster establishment of a true culture
age and benchmark the health of their
linking worker health with the market perfor- of IHS in the workplace—just as the DJSI led
workforce as a strategic asset to the
mance of the companies that employ them. to greater corporate adoption of economic,
business.”8
In 2013, for example, a study published in social, and environmental sustainability pro-
the Journal of Occupational and Environ- Other organizations are exploring sim- grams in the late 1990s?
mental Medicine (JOEM) tracked the stock ilar ideas internationally. In South Africa, for As a first step in addressing these ques-
market performance of publicly traded com- example, financial services company Discov- tions, summit participants identified emerg-
panies with strong health, safety, and envi- ery is partnering with the University of Cam- ing health and safety assessment tools,
ronmental programs. Using simulation and bridge and RAND Europe to assess worker including the Business in the Community
past market performance, a theoretical initial health in South African companies using a Public Reporting Guidelines, the Global
$10,000 investment in these publicly traded “Healthy Company Index.” The index, which Safety and Health Sustainability Index of the
companies over a 13- to 15-year span was was launched in 2011, measures the impact Center for Safety and Health Sustainabil-
shown by Fabius et al7 to outperform the of chronic disease and health and safety pro- ity, ACOEM’s Corporate Health Achieve-
Standard & Poor’s 500. Although correlation gramming on South African companies and ment Award (CHAA) Self-Assessment tool,
is not the same as causation, the results of the provides a system for them to measure the assessment programs from the Health En-
Standard & Poor’s 500 study consistently health status of their employees. A study of hancement Research Organization and the
suggest that companies focusing on the the index by the University of Cambridge and Centers for Disease Control and Prevention,
health and safety of their workforce can yield RAND Europe is underway.9 and assessment principles laid out by the
greater value for their investors—including Vitality Institute in Integrating Health Met-
competitive advantage in the market. USING THE DOW JONES rics into Health Reporting. Assessment and
The rise of interest in health and safety metrics recommendations provided in the
measures as indicators of corporate value is
SUSTAINABILITY INDICES AS A seven health and safety guidelines identified
gaining traction among thought leaders, who MODEL FOR HEALTH AND by summit participants were also reviewed
believe that a universal system of health and SAFETY MEASUREMENT (Harvard’s SafeWell, CHSWC’s Whole
safety metrics reporting could emerge as a The DJSIs were launched in 1999 Worker, NASA’s Integrated Employee Health
new standard of valuation, much as social as the first-ever set of global sustainabil- Model, CPH-NEW’s Healthy Workplace Par-
and environmental sustainability emerged as ity benchmarks, measuring the economic, ticipatory Program, the WHO’s Healthy
corporate indicators via the DJSI in the late social, and environmental impacts of cor- Workplaces, EU Agency for Safety and
1990s. porate activities. Proponents of sustain- Health’s Managing Stress, and NIOSH’s To-
In August 2014, the Vitality Insti- ability reporting argued that transparent, tal Worker Health).
tute, a global research organization focusing public reporting of these impacts was essen- Participants agreed that any proposed
on workplace health, published Integrating tial to maintain a sustainable global econ- health and safety metrics reporting system
Health Metrics into Health Reporting, a con- omy. Today, the DJSI is composed of eight would need to utilize worker health and safety
cept paper advancing the idea of public re- regional indices that include best-in-class information that is either readily available
porting of workforce health measures as a organizations—those that adhere to a robust to organizations or that could be gathered
means of gauging corporate performance and set of standards for economic, social, and en- without imposing hurdles or burdensome re-
better informing the investment community. vironmental best practices. quirements. The system would need to in-
In making the case for establishment of uni- After 15 years, the DJSI is globally clude safeguards for protecting privacy of
versal health and safety metrics, Tryon et al8 recognized by investors as the leading stan- some forms of health data and would need
noted that such a system could help US em- dard for corporate sustainability, tracking the to be constructed in a way that credibly
ployers overcome many of the barriers that performance of the world’s leading compa- translated health and safety information into
keep them from achieving a more widespread nies, and they have had a substantial im- values that would resonate with the invest-
culture of health in the workplace. The inte- pact in terms of changing organizational be- ment community. They also agreed that an
gration of health metrics into corporate re- havior and corporate culture. Organizations eventual metrics scoring system would need
porting, they noted, “builds leadership and must continually refresh their sustainabil- to include a strong degree of flexibility so
advocacy both within organizations and out- ity initiatives to be added—or to maintain that it could be adapted for use by diverse
side organizations to highlight the impor- their current position—on one of the in- organizations.
588
After close review of the principles required to demonstrate adherence to di- ganizations in diverse sectors, from publicly
of corporate public reporting generally, and verse activities aimed at ensuring engage- traded corporations to federal agencies.11
the specific reporting framework of the DJSI, ment of IHS strategies with employees, rang- The CHAA’s assessment scale mea-
participants concluded that a new health and ing from establishing and maintaining health sures a broad variety of standards for what
safety reporting system would be most fea- and safety education programs and well- it terms “healthy workplaces”—that is, each
sibly constructed in parallel to the DJSI, as communicated population-health strategies applicant’s specific occupational and en-
a complementary system utilizing the DJSI’s to providing evidence of extending equal ac- vironmental health and safety programs,
three well-established dimensions of sustain- cess to benefits, the reduction of disparities its overall company culture and organi-
ability (economic, social, and environmen- among employees in health and safety out- zational profile, and its governance. Ap-
tal). The resulting IHS Index (Fig. 1) would comes, and being a good corporate citizen plications are generally completed by a
yield values similar to and consistent with of the community—including participation cross-organizational representation of pro-
the DJSI framework. Organizations qualify- in community-wide health, safety, and envi- fessionals who are familiar with the applicant
ing for inclusion in the IHS Index would be ronmental programs. organization’s health, safety, and environ-
required to meet robust health and safety Following the blueprint for reporting mental programs, as well as its overall man-
requirements in each of the three major established by the DJSI, public reporting by agement. Applicants use the CHAA’s Self-
dimensions. companies would be extensive and would re- Assessment tool, which helps them complete
A wide range of categories would need spond to a very robust set of requirements a comprehensive review of their organiza-
to be fulfilled in each of the dimensions; for in each of the three dimensions. To achieve tion’s programs and practices.
example, to fulfill the economic dimension, recognition on the DJSI, a company assess- An independent panel of trained ex-
companies would be asked to demonstrate ment must be completed that includes a set aminers then reviews each application sub-
ongoing financial support for comprehen- of more than 100 questions; the information- mitted. Examiners look for evidence of com-
sive IHS programming, including showing sharing process that would lead to inclusion prehensive and innovative health and safety
that they adequately fund program budget- in an IHS Index would be similarly thorough. programs with measureable results. In ad-
lines for health and safety programs, that dition to looking for comprehensive pro-
sufficient training is provided for these programs, the examiners seek to understand how
grams, that well-defined benchmarks for per- the programs are deployed across the orga-
formance outcomes are in place, and that em- BUILDING THE INTEGRATED nization and how they promote the health
ployees are making progress in meeting such HEALTH AND SAFETY INDEX: and safety of the organization’s employees.
outcomes. More generally, they would need CORE COMPONENTS Points are awarded for each of 17 standards,
to demonstrate the broad economic benefit to In their review of emerging health grouped within the CHAA’s four categories.
society that derives from investment in the and safety assessment tools that could be Each organization is judged independently
health of their employees and the communi- used to help construct an IHS Index, sum- on the basis of its achievements in terms of
ties in which they do business. mit participants concluded that ACOEM’s programs, outcome measures, and organiza-
As a part of their commitment to the CHAA program offered the best currently tional trends.
environmental dimension, companies would existing platform for adaptation and they cre- Following the ACOEM/UL summit,
be required to show organization-wide re- ated a conceptual model that could build a team of participants constructed a first-
sponsiveness to a well-defined set of envi- on the CHAA’s 1000-point assessment scale. generation IHS Index that could extend
ronmental metrics, including reporting their Launched in 1996, the CHAA recognizes or- the basic methodology of the CHAA
rates of occupational and environmental ill- ganizations with exemplary health, safety, Self-Assessment tool to achieve a new uni-
nesses and injuries over time (with evidence and environmental programs. Participating versal standard of health and safety reporting.
of actions taken to improve results), showing organizations submit a comprehensive appli- The new index is scheduled to be formally
evidence of strict adherence to procedures cation about their programs and undergo a launched and available on-line as a part of
for follow-up and response to environmental rigorous review by an expert panel to assess the CHAA award-application process in early
hazards, and reporting of relevant environ- four key categories—Leadership and Man- 2015, thus providing a viable testing ground
mental inspections by regulatory agencies. agement, Healthy Workers, Healthy Environ- for the new IHS Index concept.
As a part of their commitment to ment, and Healthy Organization. Since its The scoring methodology of the pro-
the social dimension, companies would be establishment, awards have been given to or- posed IHS Index will be based on the same
FIGURE 1. Integrated Health and Safety Index.

principles that examiners use when review- to which health and safety programs exist ◦ Return-to-work programs are effectively
ing CHAA applications. The CHAA’s four within the category (worth 0% to 30%), how utilized and measured.
categories were carefully reviewed by the well these programs are deployed (worth 31% r Examples of Standards for Integrated
ACOEM/UL development team and consol- to 50%), the extent to which measurement of Health and Productivity
idated to parallel the three dimensions uti- these programs shows positive trends for the ◦ Integrated health and productivity man-
lized by the DJSI—economic, environmen- company (worth 51% to 70%), and the extent agement effectively measures the link
tal, and social—with elements from each of to which the company tracks performance of between worker health and productivity
the four original CHAA categories placed in these programs and makes improvements to and directs employer investments into
an appropriate DJSI dimension (Fig. 2). By them (worth 71% to 100%). A company that interventions that improve health and or-
paralleling the three dimensions of the DJSI, scored the maximum in each category would ganizational performance.
the IHS Index will provide a framework for achieve 100% value. ◦ Population health management is incor-
assessment that will be familiar to both the porated as an important component in
employer and investment community, thus fa- the organization’s business strategy.
Economic Dimension ◦ Efforts are made to quantify the to-
cilitating participation. r Examples of Standards for Leadership and
The CHAA’s 1000-point scale will be tal economic impact of health, in-
retained in the proposed Health and Safety Management cluding direct medical and pharmacy
Index. Organizations participating in the ◦ Organizational support and commit- costs of health care as well as indirect
CHAA will earn points and be judged on ment to health, safety, and environmen- productivity-related costs, such as ab-
their adherence to robust standards and met- tal programs and to the health, produc- senteeism and presenteeism.
rics in each of the three main dimensions— tivity, and safety of the workforce is
economic, environmental, and social. strongly demonstrated.
◦ Management provides appropriate re- Metrics
sources for IHS, encouraging innovation r Workers’ compensation
STANDARDS AND METRICS and positive change. ◦ Number of workers’ compensation
FOR AN INTEGRATED HEALTH ◦ Integrated health and safety programs claims filed annually
AND SAFETY INDEX are well aligned with pertinent regula- ◦ Total workers’ compensation costs in-
The proposed IHS Index will include tions, guidelines and best practices mea- curred each year—trend data minimum
comprehensive standards that can be applied surable goals for key IHS programs are 3 years
to any organization, whether small, medium, defined and incorporated into perfor- ◦ Total temporary disability days paid
or large. Examples of the kinds of standards mance reviews, and members of health each year
that would be expected of organizations mea- and safety teams work collaboratively r Absenteeism
suring their performance against the index and have input into decision-making ◦ Minimal cost of absenteeism—1.35 days
are included below. process related to health, safety, and en- × number of employees with given con-
In addition to a comprehensive set of vironmental issues. dition × average daily wage
standards, the IHS Index will include a care- r Examples of Standards for Absence and ◦ Maximum cost of absenteeism—10 days
fully calibrated set of metrics, included be- Disability Management × number of employees with given con-
low, which will be used to help organizations ◦ Disability management identifies indi- dition × average daily wage
arrive at a consistent measurement of their viduals and worker populations who are r Presenteeism
performance in terms of health and safety in- at increased risk of poor performance ◦ Minimal cost of presenteeism-–17.9
tegration. Metrics would be included for each because of health issues and finds pos- days × number of employees with given
of the main dimensions of the IHS Index— itive means to enhance health and pro- condition × average daily wage
economic, environmental, and social. ductivity in the workforce. ◦ Maximum cost of presenteeism-–91 days
Each of the categories within the three ◦ Illness conditions that render work un- × number of employees with given con-
dimensions in the IHS Index will include a safe and require job accommodations dition × average daily wage
geometric scoring process that assigns cumu- are closely evaluated and the workplace r Percentage of senior management reviews
lative value using four measures—the extent is used for rehabilitating workers. ◦ Number of leader/senior manager re-
views per year divided by total number
in leadership position
r Turnover rate
◦ Number of employees leaving during the
year × 100 divided by the number of
employees at the start of the year
Environmental Dimension
r Examples of Standards for Healthy
Workers
◦ Occupational health and safety pro-
fessionals routinely inspect and evalu-
ate the workplace to identify potential
health and safety hazards and subopti-
mal work practices.
◦ Appropriate health evaluations are per-
formed, and workers are fully informed
of the results of each health evalua-
tion, whether normal or if variations are
FIGURE 2. CHAA categories that parallel the DJSI dimension. detected.
590
◦ Medical surveillance programs are in ported for inspections/audits/near miss ◦ Percentage of employees completing an-
place, identifying early signs of potential and observations within due date nual laboratories/biometric screenings
hazard exposure and thus protect work- r Education and training ◦ Percentage of employees completing a
ers; appropriate infection control proce- ◦ Number of hours of training/employee primary care physician periodic well-
dures are used. as percentage of objective ness visit
r Examples of Standards for Healthy ◦ Total training days completed during r Prevalence of chronic health conditions
Environment—Workplace Environments year divided by average number of em- and health risks
◦ Health, safety, and environmental pro- ployees for the year ◦ Percentage of employees in individual
grams are in place to educate workers ◦ The percentage of employees trained high health risk levels at baseline and
about potential hazards at the worksite. prior to start of work annual follow-up. (As an example, the
◦ Effective communication procedures percentage of employees who are high
ensure that all stakeholders, both within Social Dimension risk with each of the individual 15 health
the organization and the local commu- r Examples of Standards for Engagement risks in Edington’s assessment model is
nity, are informed on an ongoing basis in Prevention and Wellness by employer/ outlined in the book, “Zero Trends.”12 )
of the identities of hazardous chemicals, employees ◦ Percentage of employees in low,
associated health and safety hazards, and ◦ Primary, secondary, and tertiary pre- medium, and high health risk categories
appropriate protective measures. vention strategies are in place, ranging at baseline and annual follow-up. (As
◦ Organizational programs focus not only from health promotion, lifestyle man- an example, this is outlined in “Zero
on workplace hazards but also the im- agement, and safety engineering pro- Trends.”12 )
pact of emissions on the community and grams to health coaching, biometric test- r Impact of health conditions
protection of the environment. ing, and active disease management. ◦ Working days lost per year by disease
◦ Health risk appraisals are used to iden- category (ie, diabetes, obesity, and hy-
Metrics tify and prioritize beneficial health be- pertension) × 100 divided by working
r Accident/incidence rates for employees, havior change programs. days available in the same year.
contractors, and fleets (trend over 5 years) ◦ Healthy vending machine and cafete- r Workplace demographics—Employee
◦ Frequency: OSHA Total Record- ria selections are available, and effective composition reflects the demographics of
able Incidence Rate employees and communication strategies are used to in- the community by sex, ethnicity, sexual
contractors—(number of OSHA record- form employees of what they can do to orientation, disability, age, etc, at multiple
able × 200,000/number of hours reduce illness, disease, and accidents. organizational levels
worked) r Examples of Standards for Value-Based ◦ Number of employees in an equity group
◦ Severity: OSHA restricted duty days Health Benefits Management × 100 divided by the total number of
for employees and contractors (num- ◦ Actuarial claims analysis for trends in employees at same point in time
ber of lost/restricted work days × diagnoses and costs are used for plan- r Community engagement
200,000/number of hours worked) ning appropriate disease management ◦ Number of community activities en-
◦ Severity: OSHA lost/restricted work- and health promotion programs. gaged in annually
day case rate (number of OSHA ◦ Pharmacy benefit plan design is used
lost/restricted workday cases × to reduce costs, while providing access
200,000/number of hours worked) to appropriate medications, and is de- HOW EMPLOYERS CAN BEGIN
◦ Vehicle accident rate: Vehicle accidents signed on the basis of beneficiary health
per year × 1,000,000 divided by total risk factors.
IMPLEMENTING IHS NOW: A
miles driven in same period ◦ The organization applies epidemiology, ROADMAP FOR OPERATIONAL
r Hazard recognition (minimum 3 years of statistics, and information systems to en- EXCELLENCE
data) sure quality of care and identification of Participants in the ACOEM/UL sum-
◦ Total number of inspections and/or au- the most effective opportunities to im- mit identified nonintegrated institutional
dits per year to include number of prove the health of defined populations silos as one of the greatest obstacles to
correct (safe conditions) and number of workers/beneficiaries. achieving a true culture of health in the work-
of adverse/at-risk (unsafe) conditions/ r Examples of Standards for Corporate So- place. Employer health and safety activities
inspection or audit cial Responsibility are often housed in completely distinct orga-
◦ Total number of near miss reported/year ◦ The organization is aligned with the nizational divisions, with minimal attempts
◦ Total number of observations reported/ goals of the community in which it oper- at integration. Although these organizational
year (safe conditions) and number ates, acting as a transparent and trusted units may have achieved programming ex-
of adverse/at-risk (unsafe) conditions/ partner. cellence within their particular area of focus,
observation reported ◦ Clear lines of communication are in they are seldom strategically linked together.
◦ Percentage of owned or leased work place linking the organization with com- The lack of integration and transcendent cor-
locations that have implemented an munity stakeholders, including public porate strategies across silos prevents optimal
occupational safety health management health organizations and safety and resource utilization and impedes efforts to
system. Percentage of those locations health agencies. maximize workforce health and productivity.
that have been audited by an indepen- ◦ The organization leverages its health and By better coordinating distinct envi-
dent third party safety policies to benefit the community ronmental, health, and safety policies and
r Participation and has strong policies in place to ensure programs into a continuum of activities, em-
◦ Percentage of workforce submitting ob- attention to issues of importance. ployers could substantially enhance overall
servations (safe, at-risk conditions), near employee health and well-being, while bet-
misses annually Metrics ter preventing work-related injuries and ill-
r Hazard prevention/closure rate r Wellness programs nesses. But typical activities incorporated in
◦ Percentage completion of corrective ac- ◦ Percentage of employees completing an workplace health and safety efforts are di-
tions for adverse (unsafe) conditions re- annual HRA verse and reflect an extremely wide range of

functions and goals. From safety engineer- r Planning: Develop a rationale for why r Good for business and help improve
ing and ergonomics to disability prevention strategic integration is important and productivity7
and behavioral health, the professionals who needed r Create a happier, less stressful, and more
implement health and safety programs of- r Assessment: Evaluate the current health prosperous business environment13
ten speak completely different institutional and safety status of the organization r Do better at their jobs and contribute
languages. r Implementation: Develop and implement more14
Acknowledging that this has been a a new, integrated strategy and vision r Are absent from work less and more pro-
longstanding reality in the practice of oc- r Monitoring: Create a system for collect- ductive when at work15
cupational health and safety, participants in ing data and for monitoring and evaluating r Enjoy their jobs more, reducing turnover
the ACOEM/UL summit formed a task force programs during implementation costs16
to develop a roadmap for integrating health r Review: Gauge progress periodically and
and safety programs for operational excel- take corrective action as needed When working to improve the safety,
lence. Made up of senior executives from health, and well-being of workers, an organi-
A brief summary of key elements of zational vision or vision statement is a power-
both the health and wellness community and
each of these phases is included in the fol- ful, meaningful commitment both inside and
the safety engineering community, the task
lowing sections: outside of the organization—and can often
force created a five-point framework specifi-
cally aimed at better aligning organizational serve as an important foundational step to-
silos and establishing sustainable integration Phase 1—Planning: Develop a ward integrated health protection and health
of health and safety teams. Rationale for Why Integration is promotion. Nevertheless, to be fully realized,
Integration and alignment of silos be- Important and Needed the vision must be reflected in both words
gins with institutional commitment and on- The first phase of integration involves and in actions. The connection of workforce
going support from the highest levels of orga- explaining the rationale for why an organi- health and safety to the values, services, and
nizational leadership. Numerous studies have zation should integrate its health and safety core products should also be acknowledged
shown that successful implementation of in- activities, and what the impact will be for by leaders and communicated widely and reg-
dividual health and safety programs in the its business. This phase involves defining the ularly. A vision and supporting mission state-
workplace is heavily dependent on senior- value of integration; engaging organization ment can help organizations:
level “champions,” who help keep teams fo- leadership, including the C-suite; articulating r Craft a human-centered culture by inspir-
cused on program goals.4 With the complex- a vision; and developing an organizational ing effective programs and policies
ity of integrating diverse health and safety op- policy statement on integrating health and r Keep health and safety issues “front and
erational teams, the commitment and active safety. center” for senior leaders because they bal-
participation of senior management teams are Key messages to communicate to ance organizational priorities
even more critical. stakeholders are that safe and healthy em- r Set the tone for interactions between mid-
With strong and sustained senior-level ployees are less likely to be injured while on level managers, front-line team leaders,
buy-in established, the details of health and the job; that they are more likely to be vibrant, and workers
safety integration can begin, using the five- engaged, and high performing; and that all of r Engage workers by seeking active worker
point roadmap developed by the ACOEM/UL these things are good for the bottom line. participation, input, and involvement
task force (Fig. 3). Essential elements A wide variety of studies have demonstrated r Show community and industry leader-
include: that healthier and safer employees are: ship to customers, shareholders, and other
constituents
The final element of phase 1 is de-
veloping a policy statement. Polices are the
enduring cornerstones of culture building be-
cause organizations begin efforts to integrate
health and safety across silos. Policies or
similar operational documents may be found
within many components of an organiza-
tion, including within business or strategic
plans, budget planning materials, human re-
sources manuals, health insurance and ben-
efits guidelines, and many other resources.
Policies can also be used to ensure participa-
tory approaches to program design and im-
plementation, promote strong program com-
munication, and to hold responsible parties
accountable for moving the vision and mis-
sion forward.
Phase 2—Assessment: Evaluate

the Current Health and Safety
Status of the Organization
The second phase of a roadmap to in-
tegration is assessment—that is, achieving a
better understanding of an organization’s cur-
FIGURE 3. Five-point roadmap for Integrating Health and Safety to achieve opera- rent status in terms of health and safety and
tional excellence. identifying metrics to evaluate its programs
592
as they evolve. Gathering information related Phase 3—Implementation: Quantifying return on investment or
to the overall health and safety of the work- Develop and Implement a New, value of investment is another action that
force and the associated metrics of health care Integrated Strategy and Vision is necessary during implementation, but this
costs and workers’ compensation claims is an Once a direction is charted through is more effectively accomplished either once
important starting point in the initial assess- the completion of phases 1 and 2, planning or twice a year. By examining the effects of
ment. Depending on the size of the organiza- and assessment, Phase 3, implementation, IHS strategies on claims cost, workers’ com-
tion, this information may reside within var- can begin. This phase involves implement- pensation costs, OSHA recordable rates, and
ious departmental silos, or perhaps with one ing the vision and strategies identified. In the disability/absenteeism numbers, managers
individual responsible for finance, account- book Leading Change, John P. Kotter, PhD, can determine whether the cost of individ-
ing, insurance, or general management. For promotes an implementation methodology to ual strategies is offset by these metrics or
larger organizations, some of the more com- achieve success.18 Several of Kotter’s general other indirect costs—such as engagement or
mon sources of assessment information, and guidelines are applicable to phase 3, which productivity.
the metrics that can be gathered from each, include: When establishing an IHS monitoring
include: plan, it is important to note that it will usu-
r Establishing a sense of urgency: This step
r Benefits: health care–related costs, partic- ally take at least 2 to 3 years before signifi-
is the catalyst necessary to break from the cant directional results can be seen, although
ipation in medical plans, short- and long- status quo on the path to achieve a new for aggressive intervention programs some
term disability vision.
r Human resources: absenteeism, workforce r
results may be evident after the first year.
Creating a guiding coalition: This team- Information should be compiled into mean-
demographics, employee turnover, job sat- building step includes seeking alignment ingful categories for stakeholders. Gathering
isfaction, and employee engagement with key stakeholders and defining the
r Risk management: workers’ compen-
information about participation in program-
roles and responsibilities of each party ming and the resulting impact in health risks,
sation insurance costs, premiums and necessary to succeed. injury rates, or environmental impacts can
losses/claims, insurance broker, carrier, r Developing a change vision: This vital step be of interest to risk management or wellness
third-party administrators helps bind the strategies that will be tied
r Safety: OSHA statistics, incidence rates,
departments. Similarly, return-on-investment
to the overall initiative and creates a com- information can be meaningful to the organi-
other safety performance metrics pelling communication of the desired end
r Operations management: productivity
zation’s chief financial officer or perhaps its
state. director of benefits. Knowing the interests of
costs per unit/output/service, key perfor- r Empowering broad-based action: This the stakeholders in an organization is impor-
mance metrics step is instrumental in developing best
r Finance or payroll: gross margin per
tant in crafting reporting to meet their needs.
practices, removing obstacles to change,
unit/service, wages, total hours worked and identifying goals and objectives to
and full time equivalent employees, orga- Phase 5—Review: Gauge Progress
achieve a vision of integration. A strong Periodically and Take Corrective
nizational structure and reporting relation- emphasis is placed on education and train-
ships (also, human resources) Action as Needed
ing in this step.
The objective of the data-gathering r Communicating the vision for buy-in: The
The final phase of integrating health
and safety activities entails reviewing
process is to determine how the organization main objective of this step is to turn words
and adjusting or developing corrective
is trending from a health, productivity, and into actions so that “what is said turns into
action as necessary. Three steps are
performance perspective. Numerous studies what is done.” Management must be per-
required—program evaluation, incorporat-
over the last several years reflect rising costs ceived as backing up its words with actions
ing lessons learned, and providing reward and
of health care and workers’ compensation in pursuit of the newly established vision.
due to the increasing percentage of workers r Phased roll-out: During this step, or-
recognition.
with chronic health conditions, such as obe- ganizations build momentum by achiev- r Program evaluation: A formal process
sity and heart disease.17 Managers should ask ing short-term successes (from 6 to 18 should be established to capture the suc-
themselves how their organization is trend- months from the planning and assess- cesses and failures of new programs. Re-
ing relative to the outcomes in these studies ment phases), consolidating these gains view should include close examination of
and what can be done to mitigate the illness by sustained action, and eventually in- anything that was expected during the pro-
burden of their workers. On the basis of the corporating these changes into workplace cess as well as anything that happened but
initial assessment, one or more opportunities culture. was not anticipated. Particular attention
may be quickly identified for improvement. should be devoted to whether appropriate
Workforce demographics, such as age metrics and goals were used and whether
Phase 4—Monitoring and
groups, geographic areas, sex, and years they have been met, and whether addi-
in position, should be taken into account Evaluation: Creating a System for tional metrics are needed to measure suc-
when assessing data and metrics to deter- Data Collection, Monitoring, and cess. Managers should also evaluate return
mine whether there are skewed outcomes Evaluation of Programs on investment. Determining the success
compared with the percentage of total work- Implemented of programs can be achieved through in-
force in the same category (ie, if 50% of Integrated health and safety programs terviews, group-discussion meetings, and
total medical cost is generated by a 35- should be monitored not only to evaluate par- anonymous surveys. These can also be
to 44-year age group that comprises 30% ticipation and engagement, but also to quan- used to promote continuous improvement.
total workforce). Generating widespread tify the value of investment. It is reasonable to A timeline for evaluation should be devel-
support for, and involvement with, data col- monitor participation in particular programs oped on the basis of key milestones in the
lection and metrics may require leveraging on a monthly basis. This will allow pro- integration process.
local, preexisting teams or committees, such gram managers to determine whether more r Incorporating lessons learned: It is impor-
as safety or wellness committees, to embrace frequent or different communications about tant to communicate lessons learned dur-
these programs—a factor in phase 3, “imple- program offerings are necessary, or whether ing the integration process so that both se-
mentation.” messages should be changed. nior leadership and employees understand

program performance and buy-in to the should advance with several guiding princi- the theoretical to the practical—including
program. Discussions should be scheduled ples in place: on-line resources, best practice compendi-
to review findings and what actions have ums, and on-site training programs, spon-
been taken to prevent or promote reoccur- r Plan with small and medium-sized orga- sored by organizations invested in the IHS
rence of issues as part of a continuous nizations in mind: The IHS model must concept.
process improvement. Next steps should be developed in a way that recognizes the r Ensure confidentiality and trust: Data
be determined from lessons learned, em- realities of small and medium-sized com- collection is an integral part of the IHS
ployee feedback, and key metric results. panies and makes it possible for them to model, but the use of data must be
r Reward/recognition: Rewards and recog- adapt core concepts. These organizations carefully managed in an environment of
nition are of key importance in incen- have unique challenges and a new model increasing regulatory complexity (Health
tivizing workers and encouraging their must be scalable for them. Insurance Portability and Accountability
acceptance of new programs. Financial in- r Apply this concept in both white-collar Act, etc). Proponents of IHS must be
centives that help promote participation and blue-collar workplaces: The service active participants in the public discussion
will aid in the success and return on in- sector and the manufacturing sector are of privacy and data protection, and data
vestment, ranging from discounts at lo- both increasingly committed to creating safeguards and well-reasoned policy
cal health clubs and healthy food choice a safe workplace. They have placed an development, balancing transparency
discounts to health insurance premium emphasis on behavioral health over phys- in reporting with data security, will be
discounts, additional days off, and direct ical challenges, but they are equally con- critically important as IHS develops.
salary/bonus payment incentives. Over cerned about issues such as ergonomics, r Align efforts with the insurance sector:
time, extrinsic rewards should be replaced business continuity, and emergency pre- Innovative models in workers’ compensa-
by intrinsic recognition that health and paredness and response. Advocacy for the tion insurance, employer-sponsored group
well-being enhances one’s performance in integration of health and safety should be health insurance, and reinsurance products
all facets of life. extended across all workplaces. that offer premium discounts to employers
r Build incentives: Integrated Health and based on the level of the employer’s IHS In-
Safety will emerge successfully if it is dex score should be promoted. This would
CONCLUSION AND well incentivized. A wide variety of in- recognize the value of these models and in-
RECOMMENDATIONS centives could be developed for organiza- centivize employers investing in evidence-
A growing body of evidence suggests tions that meet the requirements of a robust based IHS strategies that reduce the burden
that significant benefits can accrue when IHS Index—from favorable tax policies to of health risks, chronic illness, and work-
health and safety teams are more closely discounts provided by insurance carriers related injuries, thereby reducing the costs
aligned through overarching strategies and to preferred workers’ compensation rates. and financial risks of the insurer.
are integrated organizationally in the work- Organizations advancing the principles of r Encourage continued research: Although
place. Leading experts in both the health and IHS should work with other stakeholders evidence is building that healthier work-
safety communities are building programs in the health care community to develop forces provide a competitive advantage for
around the concept that health impacts safety these incentives. organizations, more research is needed to
and safety impacts health—the two, when r Build partnerships and coalitions: The better understand the dynamics of cause
properly integrated, form a continuum that IHS model will advance more rapidly and effect in IHS programming. Support
can lead to a true culture of health and safety if it has the formal buy-in and public for government organizations and aca-
in the workplace. backing of organizations from both the demic centers that are engaged in active
Supporters of the health and safety health and safety communities. This means research on this topic is vital.
continuum concept are increasing, and var- outreach to potential partners to engage
ious integration projects, initiatives, or stud- them, via research, awareness building, ACKNOWLEDGMENTS
ies are either under way or in development cosponsorship of special events, and ed- The authors thank the following indi-
at leading organizations. But uptake of the ucational activities. Pilot projects with viduals from the Centers for Disease Con-
concept in the workplace remains somewhat state governments—aimed, for example, trol and Prevention, who served as contrib-
limited. This environment could be signifi- at achieving better workers’ compensa- utors to this effort: L. Casey Chosewood,
cantly changed if more consistent definitions tion outcomes through the use of IHS MD MPH, Director, Office for Total Worker
of the components that make up successful principles— should be considered. In addi- Health, National Institute for Occupational
health and safety integration are adopted, best tion, multilevel employer communication Safety and Health; Anita L. Schill, PhD,
practices more extensively shared, and a uni- strategies that advance IHS by working in- MPH, MA, Senior Science Advisor, National
versally applicable system of measuring the clusively with professional communities Institute for Occupational Safety and Health;
value of health and safety integration is devel- such as human resources, benefits admin- and Pamela Allweiss, MD, MPH, Medical Of-
oped. In addition, employers need a new prac- istration, and labor relations will be impor- ficer, Centers for Disease Control and Pre-
tical and scalable roadmap for integration—a tant for success. vention, Division of Diabetes Translation.
guide aimed specifically at overcoming the r Develop new educational models: Inte-
problem of aligning health and safety pro- grated Health and Safety will succeed only
grams with corporate strategy across institu-
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APPENDIX 1: Integrated Health and Safety Guideline Checklist

The Integrated Health and Safety Guideline checklist below, developed by summit participants, was used to help organize an effort to compare
and contrast seven leading integrated health and safety guidelines. The checklist provides a useful tool to help employers in evaluating
integrated health and safety guidelines. Within the checklist, three levels of emphasis are designated by pluses (+):
r + = low emphasis
r ++ = medium emphasis
r +++ = high emphasis
A sample uncompleted (blank) checklist is also presented below for comparing and contrasting various guidelines.
Integrated Health and Safety Guideline Checklist – Completed Sample

Guidelines Name Name
Components
Publication date 2012 2010
Type of guidance offered by program Guideline Workbook
Audience program is geared toward Medium-size employers Large-size employers
Program level Beginner to basic Basic to advanced
Workforce focus Any-size workforce Small workforce
Downloadable and free + +++
Evidence and rationale for integration of health and safety ++ +
Scientific references ++ +
Best practices included +++ ++
Illustrative examples from the field ++ +++
Practical and accessible +++ +++
Step-by-step approach offered + +++
Management systems included ++ ++
Practical Web links and references ++ +
Approaches to obtaining senior leadership support provided +++ +
Guidance in building a business case +++ ++
Sample power points for obtaining leadership support +++ +
Checklist of integrated health and safety status Indicators ++ ++
Sample forms + +++
Guidance for goal setting +++ +++
Program planning ++ +
Budgeting +++ +
Strategies for aligning leadership at all levels +++ +
Strategies for employee engagement ++ +++
Incentive strategies + +
CEO message maps for leadership communications +++ +
Approaches for outreach to dependents ++ +
Work environment assessment ++ ++
Work organization assessment ++ ++
Individual health assessment +++ +++
Creating a plan +++ +++
Vendor selection + +
Implementation process +++ +++
Work environment interventions + ++
Work organization interventions + ++
Individual health promotion interventions +++ ++
Disease management +++ +
Disability management +++ +++
Addresses health disparities and other barriers + ++
Program evaluation strategies +++ +++
Program evaluation tools, metrics, and scorecards +++ ++
Data management ++ +++
Legal and national policy context + +
596
Integrated Health and Safety Guideline Checklist – Blank Checklist

Guidelines Name Name
Components
Publication date
Type of guidance offered by program
Audience program is geared toward
Program level
Workforce focus
Downloadable and free
Evidence and rationale for integration of health and safety
Scientific references
Best-practices included
Illustrative examples from the field
Practical and accessible
Step-by-step approach offered
Management systems included
Practical Web links and references
Approaches to obtaining senior leadership support provided
Guidance in building a business case
Sample power points for obtaining leadership support
Checklist of integrated health and safety status Indicators
Sample forms
Guidance for goal setting
Program planning
Budgeting
Strategies for aligning leadership at all levels
Strategies for employee engagement
Incentive strategies
CEO message maps for leadership communications
Approaches for outreach to dependents
Work environment assessment
Work organization assessment
Individual health assessment
Creating a plan
Vendor selection
Implementation process
Work environment interventions
Work organization interventions
Individual health promotion interventions
Disease management
Disability management
Addresses health disparities and other barriers
Program evaluation strategies
Program evaluation tools, metrics, and scorecards
Data management
Legal and national policy context


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ACOEM GUIDANCE

Integrating Health and Safety in the Workplace

JOEM r Volume 57, Number 5, May 2015 585

FIGURE 1. Integrated Health and Safety Index.

Phase 2—Assessment: Evaluate

4. Hymel PA, Loeppke RR, Baase CM, et al. wp-content/uploads/2014/06/Vitality_ .com/attachments/human-capital-consulting/

APPENDIX 1: Integrated Health and Safety Guideline Checklist

Integrated Health and Safety Guideline Checklist – Completed Sample

Integrated Health and Safety Guideline Checklist – Blank Checklist

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