Author Biographies xxiii

1 Total Worker Health®: Introduction and Overview 1
Deborah R. Roy

1.1 Introduction and Definitions 1

1.2 Five Elements of TWH 6

1.3 Hierarchy of Controls 9

1.4 Getting Started 11

1.5 Organizational Core Values 13

1.6 Identification of Metrics 14

1.7 Strategy 16

1.8 Tools for a Comprehensive Approach 19

1.9 Why Use the TWH Approach 20

1.10 Expanding OSH Practice 22

References 23

2 Risk Assessment for Total Worker Health® 27
Pam Walaski

2.1 Introduction 27

2.2 Fundamentals of Risk Assessment 29

2.2.1 Risk Identification 30

2.2.2 Risk Analysis 33

2.2.3 Risk Evaluation 34

2.3 General Risk Assessment Tools 36

2.3.1 Risk Identification Tools 36

2.3.2 Risk Analysis Tools 37

2.3.3 Risk Evaluation Tools 39

2.4 Tools Specific to TWH 39

2.5 Identifying the Top Risks to Worker Well-being in an Organization 41

2.6 Essential Elements of Applying TWH 42

2.7 Managing TWH Risk Through Hierarchy of Risk Treatment 46

2.8 TWH in Practice Focusing on Risk Management 49

2.8.1 TWH for Opioid and Abuse of Other Substances 49

2.8.2 Tobacco Use 50

2.8.3 Worker Burnout 51

2.8.4 Health Literacy 52

2.9 Conclusion 54

References 55

3 Connecting the Dots: ESG/Sustainability, Human Capital, and Total Worker Health® 59
Kathy Seabrook

3.1 Introduction 59

3.2 The Case for People, Human Capital, and Total Worker Health® 59

3.3 The Purpose of People 61

3.4 What is ESG and Sustainability-Related Risk? 62

3.5 The People, Employees, Workers, and Human Capital Connection 63

3.6 Integrating into the Business 65

3.7 More about the #TrueNorthTest 66

3.8 People and TWH Value Creation 68

3.9 Jacobs: One Million Lives 70

3.10 Where to Start the ESG, Sustainability, Human Capital, and TWH Journey? 71

3.11 Keys to Success: Integrating TWH, HC, ESG, and Sustainability 71

3.12 Mapping It Out 72

3.13 Risk Management and Covering Your Bases 74

3.14 Integrated Risk Management 75

3.15 Integrated Reporting, Materiality Assessment, and Decision-Making 76

3.16 Summary and Conclusion 79

References 81

4 Bringing Total Worker Health® into the Boardroom 85
Fay Feeney

4.1 Introduction 85

4.2 Human Capital Management 85

4.3 Board Structure and TWH 91

4.4 Vuca 92

4.5 Five Business Risks and TWH 93

4.6 The Business and Regulatory Environment Applied to TWH 94

4.6.1 ISO 45001:2018 – Occupational Health and Safety Management Systems – Requirements with Guidance for Use 98

4.7 What Safety and Health Professionals Need to Know About Corporate Governance 99

4.8 Advocating for TWH by Engaging the C-Suite 100

4.8.1 Concerns the CEO Must Evaluate 100

4.8.2 Questions Directors May Ask 101

4.8.3 ROI as Support 102

4.8.4 Topics Safety Professionals Can Bring into the Boardroom 103

4.9 Understanding What Business Leaders Care About 105

4.10 Becoming an Indispensable Partner Across the Organization 105

4.10.1 Materiality 106

4.11 Advancing TWH with CEOs and Boards of Directors 106

4.12 TWH and the Future 107

4.13 Bringing TWH into the Boardroom 108

References 109

5 Total Worker Health® and Insurance 111
Christine Sullivan

5.1 Introduction 111

5.2 Types of Insurance 113

5.2.1 Workers’ Compensation Insurance 113

5.2.2 Transitional Duty 115

5.2.3 Implementing a Return-to-Work Program 116

5.2.4 Americans with Disabilities Act 117

5.3 Health Insurance 118

5.3.1 Employee Assistance Programs as Part of a Total Worker Health® Program 118

5.4 Evaluating Your Insurance Program 120

References 121

6 TWH in Safety and Human Factors Accident Investigations and Development of Safety Interventions and Strategies 123
Rosemarie Figueroa-Jacinto

6.1 Introduction to Total Worker Health®, Safety, and Human Factors/Ergonomics 123

6.2 Sample Domains Within HF/E: 124

6.3 TWH Applied to Accident/Incident Investigations 125

6.4 Life Cycle of an Accident Investigation – Outside of Litigation 128

References 132

7 Technology Interventions and Support for Total Worker Health® 135
Linda Tapp

7.1 Introduction 135

7.2 Technology as Part of a TWH Program 137

7.3 Health and Safety Applications (Apps) to Support TWH 140

7.3.1 Physical Health Management Platforms 141

7.3.2 Mental Health Management Platforms 142

7.3.3 Health-Related Communication and Employee Education Management Platforms 142

7.4 Wearable Technology for TWH 143

7.4.1 Wearable Stress Trackers 148

7.4.2 Smart Clothing and Personal Protective Equipment (PPE) 148

7.4.3 Exoskeletons 149

7.4.4 Roadblocks and Hurdles 151

7.5 The Role of Gamification 152

7.5.1 Using Personas, Game Mechanics, and Motivators in a TWH Program 154

7.5.1.1 Personas 154

7.5.1.2 Game Mechanics 154

7.5.1.3 Motivators 154

7.5.1.4 Storytelling 156

7.6 Conclusion 156

References 156

Endnote 162

8 Ergonomics, the Aging Workforce, and Total Worker Health® 163
Rachel Michael

8.1 Introduction to an Aging Population 163

8.2 Introduction to Workplace Ergonomics 166

8.2.1 Summary 167

8.3 Ergonomics Programs 167

8.3.1 Regulatory Environment and Program History 168

8.3.2 Why Ergonomics Efforts in Health and Safety Programs Fail 172

8.4 Ergonomics as a Leading Indicator for TWH 174

8.5 Ergonomics, Ageing, TWH, and Business Metric Alignment 175

8.6 Ergonomic Design for an Aging Workforce 178

8.6.1 Physical and Cognitive Design Considerations 178

8.7 TWH Implementation Guideline as a Framework for Improved Ergonomics 186

8.8 Designing for the Future 188

References 191

9 Mental Health and Total Worker Health® 193
Subena Colligan

9.1 Introduction 193

9.2 Understanding Mental Health 195

9.3 Reasons for Mental Health Conditions 197

9.4 The Advantages of Addressing Mental Health in the Workplace 198

9.5 Mental Health and Safety in the Workplace 200

9.5.1 Physical Harm 201

9.5.2 Injuries and Accidents 201

9.5.3 Chronic Health Conditions 202

9.5.4 Psychological Harm 202

9.5.5 Excessive Workload and Burnout 202

9.5.6 Lack of Psychological Safety 202

9.5.7 Job Insecurity 202

9.5.8 Discrimination and Prejudice 203

9.6 Burnout and the Toll of Toxic Workplaces 203

9.6.1 Toxicity in the Workplace 205

9.7 Rest 206

9.8 Approaches to Promote Mental Well-being in the Workplace 207

9.8.1 Establishing a Mental Health Policy 207

9.8.2 Offer Mental Health Training 207

9.8.3 Consider Collaborating with Mental Health Providers 208

9.8.4 Alternative Work Arrangements 208

9.8.5 Employee Assistance Programs 208

9.8.6 The Importance of Breaks 209

9.8.7 Promote Supportive Work Environments 209

9.8.8 Encourage Communication 209

9.8.9 Provide Mental Health Resources 209

9.8.10 Enable Adequate Rest 209

9.9 Cultivating Mental Health in the Workplace 210

9.9.1 Encouraging Support from Top Management 210

9.9.2 Encourage Employee Involvement 210

9.9.3 Acknowledge Mental Health Awareness Days 211

9.9.4 Incorporate into the Mission 211

9.9.5 Encourage Work–Life Balance 211

9.10 Future Directions in Mental Health and Total Worker Health 211

9.11 Assessing Mental Health Programs 212

9.11.1 Clearly Define Objectives 213

9.11.2 Seek Employee Feedback 213

9.11.3 Analyze Data and Metrics 213

9.11.4 Collaborate with Mental Health Experts 213

9.12 Conclusion: The Significance of Addressing Mental Health in the Workplace 213

References 214

10 Total Worker Health® for a Remote Workforce 217
Tanya M. Conole

10.1 Introduction 217

10.2 What Is Remote Working and Who Is a Remote Worker? 218

10.2.1 What Is Remote Working? 219

10.2.2 Who Is a Remote Worker? 219

10.3 Balancing the Equation 220

10.4 The Impact of Physical Isolation on the Remote Workforce 222

10.4.1 Organizational Isolation and Loss of Workplace Social Connectivity 222

10.4.1.1 Organizational Isolation 223

10.4.1.2 Loss of Workplace Social Connectivity 224

10.5 Impact on Workforce Performance and TWH 226

10.5.1 Gathering Information and Obtaining Assistance 226

10.5.2 Loss of Soft Information (Social Cues) Regarding Workload and Progress 227

10.5.3 Collaboration 228

10.5.4 Decision Making, Work Allocation, and Performance Evaluations 228

10.6 The Dual Edges of Remote Work 230

10.7 Alternatives to in-Person Conversations and Their Impact on Remote Workers TWH 230

10.7.1 Quality of Communication 231

10.7.1.1 Why Is the Quality of Communication So Important for Remote Workers? 231

10.7.1.2 In-Person Communication 232

10.7.1.3 The Impact of Virtual Meetings on the Quality of Communication 233

10.7.1.4 Eye Contact 234

10.7.1.5 The Impact of Email and Text on the Quality of Communication 235

10.7.2 The Willingness to Speak up or Contribute 236

10.7.2.1 Isolation 236

10.7.2.2 Speaking up and Not Being Heard 237

10.7.3 Meeting Fatigue 239

10.7.3.1 An Increase in Meetings in the Same Amount of Hours … Or More 239

10.7.3.2 Time Zone Challenges 240

10.7.3.3 Back-to-Back Meetings 241

10.7.3.4 The Impact of Screen-Based Communication Tools 242

10.8 Other Considerations 243

10.8.1 Burnout 243

10.8.1.1 What Is “Burnout”? 243

10.8.1.2 Prevalence of Burnout 243

10.8.1.3 Symptoms of Burnout 244

10.8.1.4 Burnout and the Remote Worker 244

10.8.1.5 Responsibility for Management and Control 245

10.8.2 Technology Issues 246

10.8.3 Longer Screen Time and a More Sedentary Lifestyle 247

10.8.3.1 Longer Screen Time 247

10.8.3.2 A More Sedentary Lifestyle 248

10.8.4 Impact of Isolation on TWH Programs 250

10.8.5 Impact of Isolation on TWH Program Training 251

10.9 Personal Adjustment to the “Remote Work” Style 252

10.9.1 Sharing the Workplace with Family 252

10.9.2 Location 253

10.9.3 Ergonomics 253

10.9.4 Inability to Disconnect 253

10.9.5 Compatibility 254

10.10 Solutions 255

10.10.1 Take Stock, Change, and Communicate 255

10.10.2 Is a Hybrid Working Model Right for the Organization? 256

10.10.2.1 Different Hybrid Working Models 256

10.10.2.2 Factors to Consider 257

10.10.3 Normalize Meeting Declines and Remote Workers Being Unavailable 258

10.10.4 Other Tangible Solutions 259

10.11 Conclusion 262

References 263

11 Safety Committee Involvement in Total Worker Health® (twh) 267
Angela C. Ray

11.1 Introduction 267

11.2 What Does a Dynamic Safety Committee Look Like? 267

11.2.1 Clear Purpose 268

11.2.1.1 “Baking” with Purpose 268

11.2.2 Developing a Clear Purpose 269

11.2.2.1 Gather Information 269

11.2.2.2 Review, Discuss, and Decide 269

11.2.2.3 Refine and Share 269

11.2.3 Trust 270

11.2.4 Useful Communication 272

11.2.5 Follow-Through 273

11.2.6 Visibility 274

11.3 Types and Structure 275

11.3.1 Executive Safety Committee 275

11.3.2 Employee Safety Committee 276

11.3.3 Structure 277

11.3.4 Members 278

11.3.5 The Name 278

11.3.6 Bylaws 278

11.3.7 Budget 280

11.3.8 Meetings 280

11.3.9 Subcommittees 280

11.3.10 Action Item Log 281

11.3.11 Annual Training 281

11.4 Participation 281

11.4.1 The Complaint Spiral 282

11.4.1.1 Solutions to Prevent the Complaint Spiral 284

11.4.2 The Bad Actors 284

11.4.3 Develop Leaders 285

11.4.4 Perspective Shift 285

11.4.5 Deploy the Five Whys 286

11.4.5.1 Five Whys 286

11.4.6 Provide Training 287

11.5 Practical Tips within the TWH Framework 287

11.5.1 Defining Element 1: Demonstrate Leadership Commitment to Worker Safety and Health at All Levels of the Organization 287

11.5.1.1 Give EmSC a Budget 287

11.5.1.2 Provide a C-Suite Ally and Support the EmSC Mission 288

11.5.1.3 Provide a Welcome Package 288

11.5.1.4 Invest in Quality Safety and Health Training 289

11.5.1.5 Safety Day 289

11.5.2 Defining Element 2: Design Work to Eliminate or Reduce Safety and Health Hazards and Promote Worker Well-Being 290

11.5.2.1 Hazard Assessments Reviewed by EmSC 290

11.5.2.2 Flexible Work Schedules 290

11.5.2.3 Job Demands Analysis 291

11.5.3 Defining Element 3: Promote and Support Worker Engagement Throughout Program Design and Implementation 291

11.5.3.1 Safety Committee Member Involvement in OSH Department Activities 291

11.5.3.2 Healthy Workplace Participatory Program (HWPP) 292

11.5.3.3 EmSC Annual Training and Team-Building Session 292

11.5.4 Defining Element 4: Ensure Confidentiality and Privacy of Workers 293

11.5.4.1 Use the EmSC to Collect Safety Concerns 293

11.5.4.2 Safety Suggestion Box 293

11.5.4.3 EmSC Members Only Time 293

11.5.5 Defining Element 5: Integrate Relevant Systems to Advance Worker Well-Being 294

11.5.5.1 Employee Safety Surveys 294

11.6 Stretch and Flex Program Makeover … Mobility Program 295

11.6.1 Stretch and Flex Metric 295

11.7 Challenge Workplace Norms 296

11.7.1 Challenging Norms Metrics 297

11.8 Conclusion 297

References 297

12 Behavior Change Strategies and Tactics in Total Worker Health® Programs 301
Devon Tapp

12.1 Introduction 301

12.2 Introduction to Behavior Change Strategies 301

12.3 Assumptions of Behavior Change 302

12.4 Paths of Behavior Change: Motivational Interviewing 303

12.5 Motivational Interviewing Components 304

12.5.1 The Spirit of Motivational Interviewing 304

12.5.2 Oars 304

12.5.3 Communication Style 306

12.5.4 REDS Principles 307

12.5.4.1 Roll with Resistance 307

12.5.4.2 Express Empathy 307

12.5.4.3 Develop Discrepancy 308

12.5.4.4 Support Self-efficacy 308

12.6 The Process of Motivational Interviewing 309

12.7 Putting It All Together: A Motivational Interviewing Case Study 311

12.8 Learning from Related Fields 313

12.9 Summary 315

References 316

13 Total Worker Health® and Construction 319
Tricia Kagerer

13.1 Introduction 319

13.2 The Various Construction Risks That TWH Could Solve 320

13.2.1 Reputational Risk 321

13.2.2 Workforce Challenges 321

13.2.2.1 Aging Workforce 321

13.2.2.2 Physical Demands 322

13.2.2.3 Drug Addiction 322

13.2.2.4 Immigration Laws 324

13.2.3 Mental Challenges 326

13.2.4 Diversity Equity and Inclusion Challenges 328

13.3 Conclusion and Best Practices 329

13.3.1 Total Worker Health® – Solving the Legacy of Risk in the Construction Industry 329

13.3.1.1 Work Right NW 331

13.3.1.2 Turner Construction 332

13.3.1.3 Jordan Foster Construction 333

13.3.1.4 Nabholz Construction 335

13.4 The Future of Construction Depends on TWH 337

References 338

14 Total Worker Health® in the Transportation Industry 341
Alexi Carli

14.1 Industry Overview and Impact 341

14.2 Jobs and Risks 342

14.2.1 Road Transportation 342

14.2.1.1 Trucking 342

14.2.1.2 Couriers, Messengers, and Postal Workers 344

14.2.1.3 Transit and Ground Passenger/Scenic and Sightseeing 344

14.2.1.4 Warehousing and Storage 344

14.2.2 Air Transportation 345

14.2.2.1 Airlines 345

14.2.3 Rail Transportation 346

14.2.4 Maritime Transportation 347

14.2.4.1 Water 347

14.2.4.2 Harbor 348

14.3 Supporting Worker Safety, Health, and Well-Being in Transportation 348

14.3.1 Fatigue Management 348

14.3.2 Compounding Health Issues 352

14.4 Case Studies 353

14.4.1 Schneider National 354

14.4.2 J.B. Hunt 355

14.4.3 Health and Sustainability 356

14.4.4 Mental Health and Work Stress 356

14.4.5 Purolator 358

14.4.6 Amazon 359

14.4.7 Work Preparation and Conditioning 359

14.4.8 Ups 360

14.5 Driving Occupations 360

14.5.1 Acclimatization 361

14.5.1.1 Purolator 364

14.5.2 Technology and Automation 364

14.5.2.1 Amazon 365

14.5.2.2 Ups 366

14.5.2.3 FedEx 366

14.5.2.4 Shipyard and Rail Terminal Automation 367

14.6 The Path Forward – Considerations for Transportation Worker Health and Well-Being 367

References 369

15 Total Worker Health® and Manufacturing 375
Monique Parker

15.1 Introduction 375

15.2 Impacts of Manufacturing 376

15.3 Environmental Factors 378

15.4 Interventions 380

15.4.1 Osha 380

15.4.2 Knowledge 380

15.4.3 Work Environment 382

15.5 Worker Benefits 384

15.6 Challenges 386

15.7 Strategies 388

15.7.1 Top Leaders 388

15.7.2 Working Committees 389

15.7.2.1 The Education/Training Committee 389

15.7.2.2 The Development Committee 390

15.7.2.3 The Engagement Committee 390

15.7.2.4 The Support Committee 391

15.7.2.5 The Technical Committee 392

15.8 Summary 392

References 393

16 Case Studies Related to Total Worker Health® 395
Linda Tapp

16.1 Introduction 395

16.2 Case Studies and Management Support 395

16.3 Lessons Learned 396

16.4 Case Studies and Lessons Learned in Learning and Development 397

16.5 Total Worker Health® Case Studies in This Book 398

16.5.1 Case Study Summary: L.L.Bean 398

16.5.1.1 About 398

16.5.1.2 Challenge 398

16.5.1.3 Solution 399

16.5.1.4 Outcome 399

16.5.2 Case Study Summary: L’Oréal 399

16.5.2.1 About 399

16.5.2.2 Challenge 400

16.5.2.3 Solution 400

16.5.2.4 Outcome 400

16.5.3 Case Study Summary: Mental Health Initiative at Jacobs 400

16.5.3.1 About 400

16.5.3.2 Challenge 401

16.5.3.3 Solution 401

16.5.3.4 Outcome 401

16.5.4 Case Study Summary: Turck 401

16.5.4.1 About 401

16.5.4.2 Challenge 401

16.5.4.3 Solution 402

16.5.4.4 Outcome 402

16.5.5 Case Study Summary: Children’s Hospital Colorado 402

16.5.5.1 About 402

16.5.5.2 Challenge 402

16.5.5.3 Solution 402

16.5.5.4 Outcome 403

16.5.6 Case Study Summary: Morrison Utility Services 403

16.5.6.1 About 403

16.5.6.2 Challenge 403

16.5.6.3 Solution 403

16.5.6.4 Outcome 404

16.5.7 Case Study Summary: Turner Construction 404

16.5.7.1 About 404

16.5.7.2 Challenge 404

16.5.7.3 Solution 404

16.5.7.4 Outcome 404

16.5.8 Case Study Summary: Schneider Transportation 405

16.5.8.1 About 405

16.5.8.2 Challenge 405

16.5.8.3 Solution 405

16.5.8.4 Outcome 405

16.6 Additional Case Study Summaries Related to Total Worker Health® 405

16.6.1 Case Study Summary: Trucks, Inc. 406

16.6.1.1 About 406

16.6.1.2 Challenge 406

16.6.1.3 Solution 406

16.6.1.4 Outcome 406

16.6.2 Case Study Summary: Waste Management, Inc. 407

16.6.2.1 About 407

16.6.2.2 Challenge 407

16.6.2.3 Solution 407

16.6.2.4 Outcome 407

16.6.3 Case Study Summary: Remote Worker Challenges 407

16.6.3.1 Remote Worker – “TC” 407

16.6.3.2 Challenge 408

16.6.3.3 Impact 408

16.6.3.4 Solutions 408

16.6.3.5 Outcome 408

16.6.4 Case Study Summary: White Construction Group (WCG) 409

16.6.4.1 About 409

16.6.4.2 Challenge 409

16.6.4.3 Solution 409

16.6.4.4 Outcome 409

16.6.5 Case Study Summary: 3M Manufacturing Plant 410

16.6.5.1 About 410

16.6.5.2 Challenge 410

16.6.5.3 Solution 410

16.6.5.4 Outcome 410

16.7 Additional Case Studies 410

References 411

17 Resources 413
Linda Tapp

17.1 Websites 413

17.2 NIOSH Worker Wellbeing Questionnaire (NIOSH WellBQ) 414

https://www.cdc.gov/niosh/twh/php/wellbq 414

17.3 Centers of Excellence for Total Worker Health® 415

17.4 Resources from Membership Organizations 416

17.5 Calculators 416

17.6 Recommended Books 419

Index 421