NHS Health Scotland
 
  Outcome Indicators
 
 

3.13 Support for workplaces to support and enable worker health and wellbeing.(evidence)

3.13 Develop competency and capacity of workplaces to support health and work issues. (evidence)


 

Activities to support workplaces to develop and implement health and work practices and policies (in line with current legislation) will contribute to more workplaces developing and implementing effective health and wellbeing policies, and subsequently contribute to more supportive, healthier workplaces, and a safer, healthier and more productive workforce.

Rationale

Vocational Rehabilitation

Policy Note 1

Workplace health Promotion

Occupational Health and Safety

Policy Note 2

Sources

Rationale

Providing support to workplaces to develop and implement effective health and wellbeing policies will contribute to workplaces receiving timely tailored support, and ensure they are supported and enabled to provide a healthy working environment for individuals.

Informed by reviews of effectiveness evidence, NICE public health guidance 19 Managing long-term sickness absence and incapacity for work sets out principles and recommendations to guide the management of long-term sickness absence and incapacity in the workplace, and this recommends that organisational sickness absence policies and appropriate health and safety practices should be established and implemented.[1]

NICE public health guidance 06 Behaviour change at population, community and individual levels sets out generic principles and recommended actions to guide the planning, development and delivery of public health activities to change health related behaviour.[2] This includes adopting organisation wide policies and approaches, the role of line managers in supporting individuals and developing flexible working policies (see outcomes framework for mental health improvement for related outcomes and evidence). NHS Health Scotland Commentary supported these recommendations subject, where appropriate, to adaptation to fit Scottish organisational arrangements.[3]

Workers should be involved in this process at all times as there is clear evidence that programmes developed with the full participation of workers are the most effective and can result in behaviour changes in health promotion and occupational health and safety interventions.[4-7]

Review level evidence is presented in relation to the role of the workplace and workers in the following specific areas:

Vocational rehabilition and return to work services

Informed by reviews of effectiveness evidence, NICE public health guidance 19 Managing long-term sickness absence and incapacity for work sets out principles and recommendations to guide the management of long-term sickness absence and incapacity in the workplace, including recommendations for activities for employees who experience long-term sickness absence or recurring long or short-term sickness absence and activities for those individuals who are currently unemployed and in receipt of incapacity benefit or Employment and Support Allowance.[1] This includes a recommendation that employers and/or case workers (who may be suitably trained and appointed in the workplace for a coordination role), play a key role in coordinating with individuals and services to ensure timely return to and support for work. There is review level evidence:

  • for the effectiveness of occupational interventions with a return-to-work coordinator; with contact between the healthcare provider and the workplace; with early contact with the worker by the workplace.[8]

  • that improved communication between all players leads to faster return to work and less sickness absence overall, and is cost-effective, and that the duration of sickness absence is significantly reduced by contact between healthcare provider and the workplace.[7]

  • that the duration of sickness absence is significantly reduced by early and sustained contact between the employer and absent workers.[7]

 

Informed by reviews of effectiveness evidence, Waddell, Burton and Kendall [7] provide a clear set of evidence statements to guide action in vocational rehabilitation, including the impact of interventions on individuals health and work outcomes, including specific common conditions and also the process of support. The authors also conclude:

  • that workplace interventions for vocational rehabilitation should not be considered in isolation but must be integrated in to company policies for health and safety, occupational health, sickness absence management and disability management.

  • effective return to work and vocational rehabilitation interventions depend on healthcare that includes a focus on work and workplaces that are accommodating, stating that both are necessary and inter-dependent.

  • there is strong scientific evidence that the return to work process and vocational rehabilitation interventions are more effective if they are closely linked to, or located in, the workplace, and that temporarily modified work (transitional work arrangements) can facilitate early return to work for individuals with musculo-skeletal disorders.

 

Further evidence reviews provide general consensus in support of vocational rehabilitation support and services and all advocate a multi-disciplinary, bio-psychosocial, coordinated approach where all stakeholders are involved in the process and clear communication is kept up between individuals, service providers and workplaces.[8, 9] Some evidence supports the development and implementation of a general disability management intervention for employees with some chronic diseases to overcome health-related work limitations.[10]

Scottish Policy Note 1

In Health Works and the Framework for Adult Rehabilitation the Scottish Government set out a clear commitment to developing coordinated vocational rehabilitation and return to work services.

The Scottish Government will undertake a mapping of existing NHS and other provider occupational health and vocational rehabilitation services. This will improve local knowledge and understanding of service and support available within the system. The National Programme Lead for the Delivery Framework for Adult Rehabilitation, together with regional Rehabilitation Co-ordinators will ensure that all NHS vocational rehabilitation services adopt case management approaches.

Workplace Health Promotion

Many workplace interventions exist to prevent and manage common health problems, and tend to be aimed at the level of either the individual or organisation.[11] Evidence suggests that while interventions at both levels can be effective (although overall quality of evidence available on health promotion is limited), there is evidence in some areas that a combination of individual and organisational levels is most effective (e.g. combining individual consultation, skills training, and health risk education with improvements to work organisation, communication between employers and occupational health professionals and other organisational changes).[11]

Informed by reviews of effectiveness evidence, NICE public health guidance 06 Behaviour change at population, community and individual levels sets out a set of generic principles and recommended actions to guide the planning and delivery and evaluation of public health activities to change health related behaviour at the individual, community or population level, including adopting organisation wide policies and approaches, the role of line managers in supporting individuals and developing flexible working policies.[2] NHS Health Scotland Commentary supported these recommendations subject, where appropriate to adaptation to fit Scottish organisational arrangements.[3] Review level evidence suggests that supportive, flexible working policies improve employee health and wellbeing.[6, 12-15] Details of related outcomes and the evidence/evidence-informed recommendations are provided in the outcomes framework for mental health improvement.

There is mixed highly processed evidence of the impact of health promotion interventions in workplaces:

  • A series of reviews of effectiveness evidence have provided analysis which can inform planning for workplace health promotion.[6,11,16-19]

  • Informed by reviews of effectiveness evidence, the Task Force on Community Preventive Services (Centre for Disease Control) recommend assessments of health risks with feedback plus health education.[20]

  • NICE public health intervention guidance 013 Promoting physical activity in the workplace out a set of generic principles and recommended actions to guide the planning and delivery and evaluation of public health activities to change health related behaviour at the individual, community or population level, including adopting organisation wide policies and approaches, the role of line managers in supporting individuals and developing flexible working policies.[21] NHS Health Scotland Commentary supported these recommendations subject, where appropriate to adaptation to fit Scottish organisational arrangements.[22] The Scottish commentary is aimed at helping employers and workplace health professionals prevent the diseases associated with a lack of physical activity, in particular support for developing and implementing policies to support physical activities in the workplace.[22]

 

Reviews of evidence relating to workplace health promotion policies in specific topic areas have been completed by NHS Health Scotland. Details of these outcomes and the evidence/evidence-informed recommendations are provided in the other outcomes frameworks on mental health improvement, healthy weight, tobacco control, alcohol and physical activity.

Occupational Health and Safety

A limited amount of highly processed evidence has been found to date in the sources identified. It has been highlighted that there is a need for further high quality research in this area.

It is not within the scope of this paper, nor the purpose, to explore the evidence for occupational health and safety (OHS) interventions within specific business sectors or for particular health conditions. However, in addition to the clear rationale for OHS interventions, statistical evidence demonstrates where legislation has impacted on the health and safety record of organisations in the UK (see for instance Health and Safety Executive). There are also a range of systematic reviews that provide robust evidence in this area. Readers are referred to organisations such as the Cochrane Collaboration, NICE and SIGN for relevant details.

Research has indicated that small businesses lack knowledge of OHS rules and approaches, lack formal workplace systems and resources for OHS, and that information, policies and legislation do not fit the reality of small businesses.[23] Review level evidence suggests that small businesses have unique features that affect their approach to OHS and these features should be taken into account by OHS professionals and policy-makers when designing small-firm programmes and services. There is moderate evidence supporting the effectiveness of OHS interventions on health and safety outcomes in small businesses. They appear to benefit most from multi-component OHS interventions.[23]

A recent review of evidence (although not highly processed evidence) for the Health and Safety Executive identified some important emerging findings about what works in delivering improved health and safety outcomes.[4] A number of interventions were found to be effective at some level. The review also identified a knowledge gap around which levers are most effective in obtaining behavioural change in health and safety practice at an individual and corporate level. It is important to note that although the work highlights some interesting findings, for most interventions limited data was available on measures, and no interventions had been evaluated according to the scale of their impact related to the size of the problem and consequent value for money obtained. This highlights the need for further research in this area.

Scottish policy note:

The overarching aim of Scottish Centre for Healthy Working Lives located within NHS Health Scotland, is to improve the health of working age people, reduce inequalities and improve business and economic performance in Scotland, by maximising the positive outcomes arising from the relationship between health and work. The Centre offers free confidential workplace visits, practical information and advice including OHS, and a structured Healthy Working Lives Award Programme. The Award Programme is delivered throughout Scotland by Healthy Working Lives teams based in NHS Board areas. Small and medium-sized enterprises are a priority focus. Health promotion forms core components of the Award Programme.

The Scottish Centre for Healthy Working Lives and Healthy Working Lives Advisers in NHS Board areas can help and support employers to develop policies appropriate to their workforce, and workplace health improvement programmes with physical activity components.

 


Sources

  1. NICE (2009). NICE public health guidance 19 Managing long-term sickness absence and incapacity for work. NICE: London.

  2. NICE (2007). NICE public health guidance 06 Behaviour change at population, community and individual levels. NICE: London..

  3. NHS Health Scotland (2007). Health Scotland Commentary on NICE public health guidance 06: Behaviour change at population, community and individual levels. NHS Health Scotland: Edinburgh.

  4. Cox A, O’Regan Siobhan, Denvir A, Broughton A, Pearmain D, Tyers C, Hillage J (2008). What works in delivering improved health and safety outcomes. Health and Safety Executive Research Report RR654.

  5. Burton J (2010). WHO Healthy Workplace Framework and Model: Background and Supporting Literature and Practice. WHO: Geneva.

  6. Hassan E, Austin C, Celia C et al (2009). Health and Wellbeing at Work in the United Kingdom. Report prepared by the Work Foundation for the Department of Health.

  7. Waddell G, Burton AK, Kendall N (2008). Vocational Rehabilitation: What works, for whom, and when? A report for the Vocational Rehabilitation Task Group. The Stationary Office: London.

  8. Franche RL, Cullen K, Clarke J, Irvin E, Sinclair S, Frank J (2005). Workplace-based return-to-work interventions: a systematic review of the quantitative literature, Journal of Occupational Rehabilitation, 15: 607-631.

  9. Campbell J, Wright C, Moseley A, Chilvers R, Richards S, Stabb L (2007). Avoiding long-term incapacity for work: Developing a early intervention in primary care. Universities of Exeter & Plymouth Peninsula Medical School. Report for Dame Carol Black’s review of the health of Britain’s working age population.

  10. Detaille Si, Heerkens YF, Engels JA, van der Gulden JWJ, van Dijk FJH (2009). Common prognostic factors of work disability among employees with a chronic somatic disease: a systematic review of cohort studies. Scandanavian Journal of Work, Environment and Health, 35(4): 261-284.

  11. Hill D, Lucy D, Tyers C, James L (2007). What works at work? Review of evidence assessing the effectiveness of workplace interventions to prevent and manage common health problems. The Stationary Office: Leeds.

  12. Bambra C, Egan M, Thomas S, Petticrew M, Whitehead M (2007). The Psychosocial and Health Effects of Workplace Reorganisation 2. A Systematic Review of Task Restructuring Interventions. Journal of Epidemiology and Community Health, 61: 1028–1037.

  13. Bambra C, Whitehead M, Sowden A, Akers J, Petticrew M (2009). “A hard day’s night?” The effects of Compressed Working Week interventions on the health and work-life balance of shift workers: a systematic review. Journal of Epidemiology and Community Health, 62(9): 764-777.

  14. Ferrie J (2004). Work, stress and health: the Whitehall II study. Public and Commercial Services Union: London.

  15. Joyce K, Pabayo R, Critchley JA, Bambra C. (2010). Flexible working conditions and their effects on employee health and wellbeing. Cochrane Database of Systematic Reviews Issue 2. Art. No.: CD008009. DOI: 10.1002/14651858.CD008009.

  16. Aldana SG (2001). Financial impact of Health Promotion Programs: A Comprehensive Review of the Literature. American Journal of Health Promotion, 15(5): 296-320.

  17. Heaney CA, Goetzel RZ (1997). A Review of Health-related Outcomes of Multi-component Worksite Health Promotion Programs. American Journal of Health Promotion, 11(4): 290–307.

  18. Kuoppala J, Lamminpaa A, Husman P (2008). Work Health Promotion, Job Well-Being, and Sickness Absences – A Systematic Review and Meta-Analysis. Journal of Occupational and Environmental Medicine, 50(11): 1216-1227.

  19. Sockoll I, Kramer I and Bodeker W (2009). Effectiveness and economic benefits of workplace health promotion and prevention. Summary of the scientific evidence 2000 to 2006. iga.Report 13e. Initiative Gesundheit & Arbeit, Germany.

  20. Task Force on Community Preventive Services (2010). Recommendations for Worksite-Based Interventions to Improve Workers’ Health. American Journal of Preventive Medicine, 38(2) Supplement 1: S232-S236.

  21. NICE (2008). NICE public health guidance 013 Promoting physical activity in the workplace. NICE: London.

  22. NHS Health Scotland (2008). Health Scotland Commentary on NICE public health guidance 013 Promoting physical activity in the workplace. NHS Health Scotland: Edinburgh.

  23. MacEachen E, Breslin FC, Kyle N et al (2008). Effectiveness and implementation of health and safety programs in small enterprises: A systematic review of quantitative and qualitative literature.

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3.13 Develop competency and capacity of workplaces to support health and work issues.

Activities to develop the competency and capacity of workplaces to support health and work issues will contribute to developing healthy, supportive working environments in all workplaces.

This assumes that workplaces will invest in health and wellbeing instead of, or as well, as other competing priorities such as investing in core delivery skills, new technology etc.

Rationale

Policy Note

Sources

Rationale

Developing the competency and capacity of key stakeholders within workplaces will contribute to enabling workplaces to develop and implement effective and sustainable health, work and wellbeing policies and practices. Training and development for managers and workers will contribute to improved knowledge and awareness of, for instance, work-related health as well as occupational health and safety issues. The resulting reactions will contribute to changes in knowledge, beliefs, attitudes, skills, motivation and behavioural intentions, and ultimately result in increased early detection of health and work issues and a reduction in work-related ill health and injury. However, this is a complex process and assumes these activities will result in behaviour change.

Informed by reviews of effectiveness evidence, NICE public health guidance 06 Behaviour change at population, community and individual levels sets out a set of generic principles and recommended actions to guide the planning and delivery and evaluation of public health activities to change health related behaviour at the individual, community or population level.[1] This includes adopting organisation wide policies and approaches, and the role of line managers in supporting individuals and developing flexible working policies. NHS Health Scotland Commentary supported these recommendations subject, where appropriate to adaptation to fit Scottish organisational arrangements.[2]

Informed by reviews of effectiveness evidence, NICE public health guidance 19 Managing long-term sickness absence and incapacity for work sets out a set of generic principles and recommended actions to guide primary care services and employers.[3] This includes a recommendation that employers or case workers should have the skills and training to act as an impartial intermediary.

Based on reviews of evidence, the Boorman review made a series of recommendations that all NHS leaders and managers are developed and equipped to recognise the link between staff health and well-being and organisational performance and that their actions are judged in terms of whether they contribute to or undermine staff health and well-being, and that training in health and well-being should be an integral part of management training and leadership development at local, regional and national levels and should be built into annual performance assessment and personal development planning processes.[4]

Review level evidence suggests that low management commitment to training could diminish the effect of training.[5]

Development and support of proactive and integrated management systems and practices within the workplace can enable the provision of a safe and healthy working environment. There is review level evidence that the use of occupational health and safety (OHS) management systems influence the level of health and wellbeing at work.6 This might include systems developed and supported through policies, organisational goals, practices and structures within the workplace, resources, training and quality assurance and hazard control, and should integrate evaluation and organisational learning.[7] Review level evidence suggests that successful factors for the effectiveness of OHS management systems include a range of organisational factors including management commitment (strong senior management involvement, systems integral to performance appraisals, leading by example, provision of adequate resources); integration into management systems; employee involvement (employees encouraged and capable of participation, independent representation of employees encouraged and supported); and a stable workforce.[8]

Training for employees, including OHS, is widely acknowledged as an important component of occupational hazard control and risk management systems.[5] It is possible that training and education (with low, medium and high levels of employee engagement) could lead to changes in knowledge, attitudes and beliefs, behaviours, and ultimately health.[5] Informed by a systematic review of evidence Robson et al (2005) formed a set of evidence statements about the effectiveness of training interventions in OHS, and found some evidence that OHS training is effective in changing targeted OHS behaviours.[5] However, they also highlighted a lack of high quality randomised trial research on OHS effectiveness training.

Scottish policy note:

The Scottish Centre for Healthy Working Lives is working with the STUC to identify the scope for a programme to develop the wellbeing capabilities of trades union safety representatives.

The Centre promotes healthier and safer workplaces, by reviewing working environments and offering Scottish employers guidance and support in the implementation of successful health and safety and employment policies, and supporting training and capacity development within the workplace.


Sources

  1. NICE (2007). NICE public health guidance 06 Behaviour change at population, community and individual levels. NICE: London.

  2. NHS Health Scotland (2007). Health Scotland Commentary on NICE Public Health Guidance 06 Behaviour change at population, community and individual levels. NHS Health Scotland: Edinburgh..

  3. NICE (2009). NICE public health guidance 19 Managing long-term sickness absence and incapacity for work. NICE: London.

  4. Boorman S (2009). NHS Health and Well-being. Final Report. Department of Health: London.

  5. Robson L, Stephenson C, Schulte P et al (2010). A systematic review of the effectiveness of training and education for the protection of workers, Institute of Work and Health: Toronto.

  6. Hassan E, Austin C, Celia C et al (2009). Health and Wellbeing at Work in the United Kingdom. Report prepared by the Work Foundation for the Department of Health.

  7. Robson L, Clarke J, Cullen K et al (2005). The Effectiveness of Occupational Health and Safety Management Systems: A Systematic Review. Institute for Work & Health: Toronto.  

  8. Gallagher C, Underhill E and Rimmer M (2001). Occupational Health and Safety Management Systems: A Review of their Effectiveness in Securing Healthy and Safe Workplaces. National Occupational Health and Safety Commission: Sydney.

 

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