What really improves employee health and wellbeing: Findings from regional Australian workplaces

Abstract

Purpose
– Factors for successful workplace health promotion (WHP) are well described in the literature, but often sourced from evaluations of wellness programmes. Less well understood are the features of an organisation that contribute to employee health which are not part of a health promotion programme. The purpose of this paper is to inform policy on best practice principles and provide real life examples of health promotion in regional Victorian workplaces.

Design/methodology/approach
– Individual case studies were conducted on three organisations, each with a health and wellbeing programme in place. In total, 42 employers and employees participated in a face to face interview. Interviews were transcribed verbatim and the qualitative data were thematically coded.

Findings
– Employers and senior management had a greater focus on occupational health and safety than employees, who felt that mental/emotional health and happiness were the areas most benefited by a health promoting workplace. An organisational culture which supported the psychosocial needs of the employees emerged as a significant factor in employee's overall wellbeing. Respectful personal relationships, flexible work, supportive management and good communication were some of the key factors identified as creating a health promoting working environment.

Practical implications
– Currently in Australia, the main focus of WHP programmes is physical health. Government workplace health policy and funding must expand to include psychosocial factors. Employers will require assistance to understand the benefits to their business of creating environments which support employee's mental and emotional health.

Originality/value
– This study took a qualitative approach to an area dominated by quantitative biomedical programme evaluations. It revealed new information about what employees really feel is impacting their health at work.

Full text

International Journal of Workplace Health Management
What really improves employee health and wellbeing: Findings from regional Australian
workplaces
Virginia Dickson-Swift Christopher Fox Karen Marshall Nicky Welch Jon Willis
Article information:
To cite this document:
Virginia Dickson-Swift Christopher Fox Karen Marshall Nicky Welch Jon Willis , (2014),"What really
improves employee health and wellbeing", International Journal of Workplace Health Management, Vol. 7
Iss 3 pp. 138 - 155
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http://dx.doi.org/10.1108/IJWHM-10-2012-0026
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What really improves employee
health and wellbeing
Findings from regional Australian workplaces
Virginia Dickson-Swift
Rural Health School, La Trobe University, Victoria, Australia
Christopher Fox
Faculty of Medicine – Sexually Transmitted Infections Research Centre,
University of Sydney, Sydney, Australia
Karen Marshall
Rural Health School, La Trobe University, Victoria, Australia
Nicky Welch
Prevention & Population Health Branch, State Government of Victoria,
Melbourne, Australia, and
Jon Willis
Aboriginal and Torres Strait Islander Studies Unit, University of Queensland,
Brisbane, Australia
Abstract
Purpose – Factors for successful workplace health promotion (WHP) are well described in the
literature, but often sourced from evaluations of wellness programmes. Less well understood are
the features of an organisation that contribute to employee health which are not part of a health
promotion programme. The purpose of this paper is to inform policy on best practice principles and
provide real life examples of health promotion in regional Victorian workplaces.
Design/methodology/approach – Individual case studies were conducted on three organisations,
each with a health and wellbeing programme in place. In total, 42 employers and employees
participated in a face to face interview. Interviews were transcribed verbatim and the qualitative
data were thematically coded.
Findings – Employers and senior management had a greater focus on occupational health and safety
than employees, who felt that mental/emotional health and happiness were the areas most benefited
by a health promoting workplace. An organisational culture which supported the psychosocial needs
of the employees emerged as a significant factor in employee’s overall wellbeing. Respectful personal
relationships, flexible work, supportive management and good communication were some of the key
factors identified as creating a health promoting working environment.
Practical implications – Currently in Australia, the main focus of WHP programmes is physical
health. Government workplace health policy and funding must expand to include psychosocial
factors. Employers will require assistance to understand the benefits to their business of creating
environments which support employee’s mental and emotional health.
Originality/value – This study took a qualitative approach to an area dominated by quantitative
biomedical programme evaluations. It revealed new information about what employees really feel is
impacting their health at work.
The current issue and full text archive of this journal is available at
www.emeraldinsight.com/1753-8351.htm
Received 17 October 2012
Revised 11 November 2013
Accepted 10 January 2014
International Journal of Workplace
Health Management
Vol. 7 No. 3, 2014
pp. 138-155
rEmerald Group Publishing Limited
1753-8351
DOI 10.11 08/IJWHM -10-201 2-0026
This study was funded by the State Government of Victoria Department of Health. The authors
would like to acknowledge the contribution of the State and Regional Department of Health and
Bendigo Community Health Services as partners in this project, as well as the participating
organisations and their employees.
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Keywords Australia, Organizational culture, Qualitative research, Workplace health,
Health promotion, Mental and emotional health
Paper type Research paper
Introduction
Globally the workplace has been recognised as a key contributor to the health and
wellbeing of working-age people (European Network of Workplace Health Promotion,
2005; Black, 2008; European Agency for Safety and Health at Work, 2010). Health
promotion in the workplace has been broadly recommended by international bodies
through numerous charters and declarations, including the 1986 Ottawa Charter for
Health Promotion, the 1997 Jakarta Declaration on Leading Health Promotion into
the 21st Century and the 2005 Bangkok Charter for Health Promotion in a Globalized
World (World Health Organization, 2008). The European Network for Workplace
Health Promotion has issued a number of statements in support of WHP, including the
Luxembourg Declaration on Workplace Health Promotion in the European Union,
the Lisbon Statement on Workplace Health in Small and Medium Sized Enterprises
and the Barcelona Declaration on Developing Good Workplace Health Practice in
Europe (European Network of Workplace Health Promotion, 2005). In addition to these
there are a number of other programmes in place across the US, UK, Canada and
New Zealand (European Network of Workplace Health Promotion, 2005; Buck
Consultants, 2008; Bull et al., 2008; Health Work and Wellbeing UK, 2008).
The workplace has been recognised as a key contributor to the health and wellbeing
of individuals since the Ottawa Charter for Health Promotion stated “work and leisure
should be a source of health for people” (World Health Organization, 1986). More
recently a Global Plan of Action on Worker Health was endorsed by the World Health
Assembly in 2007 (World Health Organization, 2007) and in 2009 the World
Health Organization released a comprehensive model for action that advocates for an
approach to worker health which incorporates physical health, psychosocial health,
healthy behaviours and environmental determinants (World Health Organization,
2010). Promoting health in the workplace improves employee health and wellbeing,
enhances productivity and therefore the success of organisations (Harden et al., 1999;
Benedict and Arterburn, 2008; Black, 2008). The reduction of risk factors for lifestyle
diseases will improve health status and reduce the burden of disease (Australian
Institute of Health and Welfare, 2010). There is strong evidence that small widespread
changes to the workplace environment can result in significant health improvements
for workers and their families (Makrides et al., 2007; Bellew, 2008; Black, 2008).
WHP can be any activity that aims to improve or promote the physical or mental
health and wellbeing of employees in their workplace. The range of different roles
and job sites mean that this is necessarily a broad and encompassing definition (Hymel
et al., 2011). Traditionally workplace health has concentrated on occupational health
and safety (OH&S) measures with the aim of reducing physical harms and injury to
employees. Many employers continue to view their obligations to the requirements
of OH&S laws as the extent of their role or responsibility in their employees’ health and
wellbeing. The value of supporting employee health results in positive outcomes for
the organisation as a whole with reported increases in productivity and reduced
absenteeism (Benedict and Arterburn, 2008; Black, 2008).
Historically, WHP has focused on physical health which ultimately relies on
individual behaviour change and biomedical measurements such as blood pressure
and weight loss despite the greatest individual benefits being social and emotional.
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Contemporary OH&S approaches often include individual screening programmes that
are conducted on employees to determine these biometric measures such as blood
pressure, or behaviour patterns such as inactivity or excessive alcohol consumption
(Worksafe Victoria, 2012). In this form it is up to the employees to seek to change
their individual behaviour to improve their health. These type of WHP programmes
have been widely criticised for having a narrow individual employee focus with
many interventions directed solely at individual employee behaviour change without
paying attention to the contributing role of physical (e.g. facilities, buildings, furniture
etc.) and psychosocial workplace features (e.g. social support, social norms,
management styles, organisational cultures) to employee health (Chu et al., 2000;
Marshall, 2004; Black, 2008). These individual behaviour change programmes
have limited success (especially beyond the duration of the programme) when run
as a “one off”, often attracting those already motivated to participate or change their
behaviour (Marshall, 2004).
In recent years there has been a substantial broadening of the concept and scope
of workplace health from those programmes focusing on screening and individual
approaches, to considering the workplace as a whole setting with multiple influences
and opportunities (Hooper and Bull, 2009). A comprehensive review of workplace
health and physical activity (WPHA) programmes in Australia undertaken by
Ackland et al. (2005) found that WPHA programmes have the potential to increase
health awareness and motivation to change health behaviours but more importantly
they also noted that “the important benefits were primarily personal and social, rather
than organisational” (p. 7). Although WHP is becoming more popular with many
programmes implemented in workplaces in Australia and elsewhere, the research
evidence base is still strongly focused on reporting results often related to individual
behaviour change (Hooper and Bull, 2009).
Workplace stress is another important aspect that requires consideration when
examining WHP. Chronic exposure to stressful situations at work coupled with
poor management support has been linked to a range of health conditions including
depression, anxiety and cardiovascular disease. Stressful working conditions can also
impact on employee health and well-being by limiting an individual’s ability to make
positive lifestyle changes (e.g. smoking or alcohol overuse). WHP programmes that
focus almost exclusively on individual lifestyle changes such as diet, exercise and
smoking with little or no consideration of the contribution that the workplace itself
(both the physical space and the organisational culture) can make to such behaviours
are of limited benefit. WHP programmes directed at assisting people to cope with
stressful working conditions without addressing the actual working conditions
themselves contravene the OH&S legislation that exists in many industrialised
countries including Australia, Canada, New Zealand, UK and the US (Chu and Dwyer,
2002; Noblet and LaMontagne, 2006).
Despite a plethora of international studies documenting many of the successes of
WHP programmes and many Australian reports commissioned by government
departments, quality evidence of what works in individual organisations is lacking
(see, e.g. Bellew, 2008; Comcare, 2010; Hooper and Bull, 2009; The Health and
Productivity Institute of Australia, 2010) Even with a growing interest in the
importance of WHP programmes in addressing employee’s health and wellbeing
there is still limited evidence that explores the success factors of WHP programmes in
the Australian context focusing on the perspectives of employers and employees. The
Victorian State government, through the Department of Health acknowledged this by
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providing funds for research to investigate current WHP programmes and strategies
with a view to informing future policy directions.
The aim of this study was to inform policy on best practice principles and provide
real life examples of health promotion in regional Victorian workplaces.
The objectives
To explore employers’ understanding of work place health.
To explore employees’ understanding of work place health.
To identify benefits and barriers to workplace health programmes.
This study did not attempt to define “WHP” or “health”. The participants in this study
were free to interpret health and wellbeing any way they chose. This enabled
the inclusion of data about factors which impacted on health and wellbeing that may
not have fallen under the banner of a defined WHP programme. This study did not
define the “benefits” of WHP. Many studies have limited their measurement of benefits
to individual biomedical or behaviour indicators such as reduced blood pressure,
weight loss or smoking cessation. In line with the broad scope of this study the benefits
to an individual or an organisation were not limited in this way by the researchers.
Method
A case study approach using mixed methodology was used to document and
investigate the WHP programmes in three Victorian workplaces (Stake, 2008; Grbich,
2012). The case study approach allowed for an examination of the unique factors
impacting on WPH for each of the participating organisations. Each organisation
had an established WHP programme in place. The data collection methods included
individual interviews with employers and employees which were then followed up by a
survey. For the purposes of this paper, we have focused on the qualitative component
presenting the results from thematic analysis of the interview transcripts (Ezzy, 2002).
The rationale for this is that it provides a unique insight into the perspectives of the
employers and employees regarding their understandings of WHP and the barriers
and benefits of such programmes within their organisations.
Profile of the participating organisations
Each of the three participating organisations is located in regional Victoria. They were
selected for inclusion into the study based upon their established WHP programmes
and commitment to employee wellbeing.
The largest of the three organisations is a national public company and a major
employer in Victoria. Its head office is based in regional Victoria with approximately
900 white collar employees. Only employees who worked at this site were eligible for
this study. A key feature of this organisation is the recently completed purpose built
head office which has a focus on employee health and comfort and a commitment to the
environment through a five star energy rating.
The second organisation is a local government authority. This organisation
employs approximately 193 full time and part time employees across a range of
sectors including administration, manual outdoor, service delivery and early childhood
education. The employees are spread across a large geographic area of approximately
6,500 square kilometres, with many having no regular contact with colleagues in different
sectors or localities. Worker health checks (screening for risk factors such as high blood
pressure, overweight and fruit and vegetable intake) and health information sessions are
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regularly provided by a visiting community health service. At the time of this study, a
staff survey had recently been completed by the organisation to ascertain the needs of
staff in future planning of their health and wellbeing programme.
The third organisation is an owner operated manufacturing company with eight
national sites. The regionally located head office was the workplace of all the
employees who participated in this study. At the time of the study, the company
employed approximately 80 people at this site. Employees were engaged in manual
duties with a small number employed in administration roles. A long standing
relationship with the local community health service has allowed the company to
incorporate a range of health information sessions and worker health checks into
business activities. The cornerstone of the health programme is their on-site counsellor
who has been employed two days a week for the last three years. Her services are
available to all staff and their family members, paid for by the company.
Data collection and analysis
Semi-structured interviews were conducted with management and employees from
each organisation to understand perspectives and issues in the development and
implementation of workplace health programmes (Grbich, 2007, 2012). The interviews
took place at the workplace within normal working hours and were typically between
30 minutes to one hour in duration. With the permission of each participant, the
interview was recorded and transcribed verbatim. The interviews were followed by
a survey measuring participation in workplace health programmes, and aspects of
the programmes including acceptance, understanding and potential benefits on
a workplace level. The results from the survey are reported elsewhere.
The qualitative interview data was transcribed, coded and thematically analysed
with individuals’ quotes used to highlight the main findings. The quotes appear in
italics in the results section below. All data were coded and analysed by one researcher
who had conducted each of the interviews to ensure consistency and rigour
(Green et al., 2007). For conciseness and confidentiality the data from each organisation
will be combined and not presented as individual cases.
Recruitment
Participation was open to all management and employees of each of the organisations.
Promotion of the study was tailored to each organisation. Strategies included
online and physical noticeboards, staff meetings and researcher attendance to
introduce the study. Recruitment was by participant sign up and was facilitated by
each organisation. Word of mouth peer recommendations encouraged more employees
to participate in interviews.
Participants
In total, 42 interviews were conducted across the three organisations. This number
included at least one member of senior management at each workplace including the
three CEOs. In total, 19 of the interviewees were female, 23 were male.
Results
To protect the identity of the organisations and the confidentiality of participants
the results are presented as a compilation of the interview data from the three
organisations. For the purposes of this study, “employers” also included key senior
management personnel.
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A definition of workplace health: employers
Differences between employers’ and employees’ understanding of workplace health
were apparent. For employers a strong focus on OH&S was evident, with employers
citing policies and procedures to maintain personal safety and avoid injury. Employers
also focused on productivity, with health (physical and mental wellbeing) a necessary
prerequisite for being “able to cope” with the demands of the job to meet expected
standards. Activities such as training, supervision, counselling, management
support and OH&S measures was understood (if not eloquently described) to be
workplace health. Activities believed to improve the physical capabilities and/or
psycho-emotional capacity to cope with the requirements of a position were included in
definitions of workplace health. Despite each organisation having a self-declared
commitment to employee health and wellbeing, including the existence of strategic
plans, the employers interviewed typically struggled to define or describe workplace
health/WHP:
Yep look I think it’s very important that people do have that health and wellbeing so that they
can cope with what gets put before them because [y] we have an obligation I think to our
people that they can perform the roles that they are given and that they are given the training
[y] and the support to make sure that they can cope. So it’s really about making sure that
they have got the capacity to do what they are being asked to do.
Some employers felt workplace health was more than “a capacity to do what is
being asked”. Others suggested workplace health included providing the conditions
for personal development and allowing individuals to become the best they can be
through opportunities provided to them within the workplace. This view was based
on a humanistic belief that employees were entitled to have opportunities for
self-improvement at work. It was these employers that focused more on health
promotion rather than primarily illness or injury prevention:
Well we think that workplace health the opportunity to offer a focus on health and health
programs to the people who work here that it is not just to benefit their work but [also to
benefit] their lives [y] In general we have an attitude to learning and development and
health is just part of it. Simply it has got nothing to do with anybody working better. We just
like to provide opportunity for people so that they improve their life and that is what actually
happens with the Workplace Health Program in that it spills over into their private life-the
ripple effect is enormous.
A definition of workplace health: employees
Employees also acknowledged the role of OH&S measures in workplace health,
however, the main focus of their responses focused on mental health, emotional
wellbeing and happiness. Employees reported that good emotional health comes from
working in a respectful workplace, whereas poor emotional health can be caused by or
made worse by an unhealthy working environment. Typically employees reported that
they could take care of their physical health outside of work, but what really mattered
at work was their mental and emotional wellbeing:
It’s fantastic to have the health programs. You really feel that they put you first as a person
and your health first because if you are healthy you are going to be a better worker.
I am appreciated for what I do, that is really, really important and that’s probably one of the
biggest factors in as far as workplace health is that if you don’t feel appreciated you are not
going to be healthy in your job and I do feel like I am appreciated.
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What makes a health promoting workplace?
Respondents (which will hereafter refer to both employers and employees) identified
many health promoting features within their organisation as having a positive impact
upon their health. These can be grouped into three aspects:
(1) The organisational culture of a workplace: this includes management and
hierarchy structure, management/ staff communication, friendly staff
interactions, flexible work options such as part time, work from home, or
time in lieu and how easy it is to use these options. It is also about the “feeling”
within an organisation – all those little things that make an employee say “this
is a great place to work”. It’s not about the perks offered to employees – it’s
about how the organisation operates its day to day business. If this is in
a way that respects employees, their needs, their family commitments, and
their ideas, then it is likely that organisation has a “good culture”. This aspect
will be expanded upon later in the paper.
(2) WHP programmes: these are add-on programmes often about a specific health
topic that are run at work in or outside normal working hours. They take many
forms which often include some aspect of individual behaviour change as the
intended outcome:
.Health information session topics include men’s health, women’s health,
quit smoking, diabetes education, healthy cooking, sleep and relaxation.
.Fitness programmes can include workplace team or individual fitness
challenges run for a specified amount of time, healthy eating programmes
designed to increase fruit and vegetable intake and reduce unhealthy food
intake, walking groups or provision of pedometers to staff, subsidised gym
memberships and/or lunchtime yoga.
.Medical screening includes hearing tests, blood pressure/weight/
cholesterol/heart/skin checks and influenza vaccinations. These are also
known as Worker Health Checks.
.Training can include training in leadership, communication, personality styles,
bullying prevention, first aid, ergonomics, manual handling and heavy lifting.
(3) Amenities: these are somewhere between organisational culture and health
promotion programmes. These amenities often reflect the culture of an
organisation and its level of commitment to the health of employees and
the importance of a healthy and happy workforce for organisational harmony
and good productivity.
These amenities can include physical aspects of the organisation’s property such as
a large staff room with outdoor seating, a childcare centre, a homework room for
employee’s children, comfortable chairs and opening windows. It can also include
smaller items such as tea/coffee and newspapers in the staff room, fresh fruit, and
employer supplied breakfasts, morning tea or lunches for special occasions.
Benefits of WHP
There are benefits to the organisation and the individual worker. Employees and
employers reported that the organisations benefited from an increase in productivity,
staff retention, staff morale and loyalty, a reduction in absenteeism and the
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organisations gain a reputation as a great place to work. The quote below typifies
the responses from employers:
What do we get for [having a health and wellbeing program]? We get a more productive work
force. More importantly we get a reputation as a really good place to work that really cares
about their staff and so people want to work here. So we get to cherry pick the best out of the
employment pool.
Employees report improvements in happiness, confidence, job satisfaction, physical
health, work ethic, healthy behaviours such as increasing fruit and vegetable
consumption and decreasing alcohol intake, and a gain in enthusiasm for healthy
choices which is often shared with family members resulting in healthy meal options
for example. When employers make an effort to do something for the good of the
employees, such as offer flexible time, run a health information session or have a staff
BBQ at lunchtime, employees feel willing to repay this through extra hard work.
Employees often reported a perception of being cared for by employers through the
programmes on offer as highlighted in the excerpts below:
I think that it is really good [that my boss cares for me through providing programs]andIthink
that it probably shows in the stuff that we make because we want to actually do a good job.
It’s good, it’s a good place to work, it is [like] a family environment [y] you feel like you are
part of something.
Employees like programmes that:
.are free;
.are confidential;
.are easy to participate in;
.are enjoyable;
.make them feel valued;
.offer opportunities for socialising;
.increase health and wellbeing knowledge;
.increase motivation;
.develop personal skills; and
.are available in work time.
Barriers to WHP
Organisations may be reluctant to undertake WHP with employers reporting that
worker safety is their responsibility but worker health is not. Barriers exist for
employees to engage with health promotion programmes. This is often due to time.
Outside of working hours many employees have other commitments and priorities
and will not return to work for an evening programme. Inside of working hours,
employees are reluctant to give up their lunch break for a programme. They may
also resist participating in a programme if their work piles up when they are away or
they will suffer disapproval from their managers or co-workers for their absence:
One bloke there had to go to the Quit course and his boss said “You can’t go to that you have
got something else that you have got to do” – so he didn’t go.
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Employees did not like programmes that:
.lack choice;
.lack staff engagement;
.lack management support;
.are poorly timed;
.focus on just information provision;
.are not targeted to specific issues;
.are not targeted to specific audiences;
.are repetitive; and
.are based on a “one size fits all” model.
Organisational culture and its influence on health
The following organisational aspects emerged as important factors which impacted on
the health promoting environment within the organisations. These factors repeatedly
arose when participants were discussing mental and emotional wellbeing which was
reported as being more important at work than physical health.
Management support
Commitment by all levels of management to a respectful culture and to WHP
programmes was a motivating factor for employees to participate in the programmes
and model the respectful characteristics. Where management support was lacking
or different levels of management displayed differing commitment to WHP, the
employees felt less motivated to participate in WHP programmes:
[The manager] is always trying to get people to do [the health promotion programs],
to get involved with it because she wants everyone else to stay healthy at work and she
doesn’t mind if it takes a bit of our work day out just to make sure that we are healthy.
An employee of the largest of the organisations whose job it was to promote health
and wellbeing in the workplace revealed that gaining top level executive support
for health promotion initiatives was sometimes hard due to competing priorities. In
a post global financial crisis environment there could be resistance to items not
considered to be “core business” or a lack of time for the executive members to focus on
WHP which may not be considered important in the bigger scheme of things. Business
downturn is one possible reason for core business to be prioritised, however rapid
business growth was another reason given for lack of management support for WHP
programmes. Management was considered too busy to either notice or care about
small WHP initiatives:
We provide tea, coffee and biscuits and I just think “biscuits you know it is not a fantastic
idea”. I would rather be providing fruit or something like that so if I put up to them [the
executive members] that we should be changing the biscuits to fruit they probably would be
just thinking “Nah this is not a priority at the moment”.
Workplace flexibility
One of the most valued things for many employees was workplace flexibility with many
employees referring to family friendly policies as being the best thing about their jobs.
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They described their workplaces as being supportive, caring, valuing of employees,
family friendly, flexible and assisting with a work/life balance. Such things as working
school hours, access to flexi-time and the readiness of management to support these
types of arrangements were highly valued:
Well when I started I was coaching the junior soccer team so they let me go like fifteen
minutes early to get there on time and like you know you put in the extra ten minutes at the
start of the day, so they are really flexible with things like that.
Communication
When employees feel they have an approachable boss and communication between
management and employees is two-way, easy, frequent and respectful, employees
report feeling valued, able to express their ideas with confidence, and well supported in
their day to day role. This was considered an especially significant aspect to the
enjoyment of their jobs by a majority of employees:
Being able to actually talk to my manager about a lot of my personal stuff so that helps my
mental health.
One manager stated that:
What we want to develop here is a place whereby not only are [staff] encouraged to have their
ideas they are encouraged to be able to articulate those ideas and have the self-confidence to
share those ideas and then also be recognized for having them and being engaged and
involved in the implementation of those ideas. We don’t want them to sit on their hands
and be quiet and have great ideas and just let the time pass. We don’t want that. We want
much more than that and the workplace health program is a big part of that.
The smallest of the three organisations had a counsellor who worked two days a week
attending to employees and their families. She provided a valuable alternative avenue
for communicating about work and personal issues. An employee described what
having the service of the counsellor meant to him:
It just shows how much they [the employers] care about their staff and making sure that their
minds are healthy and making sure that they are feeling better about themselves I suppose.
Personal relationships
Employees like to feel valued and to know that their boss actually cares about them as
a person. Attributes like respect, trust, caring, being approachable and the ability to
develop personal relationships with different levels of management was important for
many employees:
The people in management often ask how you go. The family that runs the business know
about me and they ask about [my wife], they remember my wife’s name, my oldest son they
have met a few times they remember his name and ask about him.
Rewards
Rewards were reported across the three organisations. Rewards included financial
bonus payments, movie tickets, employee of the month/year awards and staff parties.
It was not the size of the reward that was important, but rather the intention and the
manner with which the reward was given. Rewards had more meaning to employees
and increased the employee’s sense of self-worth more when they were personalised
(not given to everyone), unexpected (not a part of a regular bonus system), directly
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linked to an event or period of time (e.g. as a thank you for hard work over the busy
Christmas period) and personally given by management to the employee (the value
was reportedly lessened when supervisors rather than the most senior manager gave
the reward). Peer nominated rewards were also valued highly:
My area had a lot of problems at that stage. We had a few people cause us a few problems and
they quit and after they left the area picked itself up and kept going and management noticed
that we were doing really well. So they gave us all movie tickets.
[It was] something small but it actually means something if it comes from management. It is
good to know that management knows that we are working hard.
Physical spaces
Employees often referred to the physical environments in which they worked mostly
citing factors relating to their immediate work stations (ergonomics and comfort). For
some the physical space was one of the best things about their work environment with
clean, bright open spaces as being important. The provision of car parking, bike
shelters and showers were also seen as positives. Each of the organisations had made
some provisions relating to family friendly environments including such things as
separate rooms for employees’ children to do homework, to attend work with a parent,
and for breastfeeding employees to feed their infants. The manufacturing organisation
had implemented a system of ordering, storing and streamlining the raw materials at
their factory site acknowledging the mental health benefits of working in an organised
environment:
It feels rewarding to be here in a building like this.
It is great to have a family friendly environment where I don’t feel at all any pressure if I bring
kids into work or anything like that, there is no stresses. We are very lucky from that point
they have an area here where you can breast feed [y] and that is fantastic.
The common benefit resulting from the organisational aspects detailed above
was the feeling of being valued. Feeling valued was described during the interviews
as associated with good mental and emotional health. Previous studies have not
revealed this as a factor of WHP potentially because many of them focus on
quantitative outcome measures only. All of the organisational aspects are interrelated
and each can contribute to increasing an employee’s sense of feeling valued. For
example the physical environment can facilitate communication and peer interaction
by having a large staff room dining table; the provision of newspapers at the table
leads to shared discussions and finding things in common with co-workers;
the resulting relationships provide good social support both inside and outside of the
workplace.
Figure 1 depicts the components of a health promoting workplace as reported by
the participants in this study. A strong emphasis on mental and emotional health is
evident through the prioritising of interpersonal relations (personal relationships,
communication and management support). Physical health programmes are not
present in the figure as in and of themselves they will not create a health promoting
workplace. The components in the figure are essential foundations for improving
health in the workplace. Once the components are in place in an organisation,
additional programmes to improve physical health may be implemented and are more
likely to achieve their aims.
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Discussion: what makes for successful WHP?
The breadth of participant’s responses demonstrates how extensive WHP can be.
Emotional and mental wellbeing which employees reported as being strongly
influenced by their workplace has not to date attracted the same interest or funding as
physical health improvement campaigns such as the Victorian state government
funded work health checks. The improvement of mental and emotional health comes
through the “culture” of a workplace supporting the psychosocial needs of employees
(Noblet and LaMontagne, 2006). This culture is embedded into the organisational
structure of a workplace and is not a discrete health promotion programme. Simple
strategies can support this, such as encouraging managers and staff to praise their
co-workers for a job well done which will assist to build a culture within the
organisation that does not take these small things for granted. Employees in our study
reported that something as simple as receiving a birthday card or movie tickets in
recognition of extra effort can make a difference. Employees need to feel valued in their
role. This has very little to do with the role’s status and everything to do with how an
employee is treated. Employees appreciate when management know the role and
importantly know how the employee is going. These findings were supported in
a quantitative study by Arnold and Dupre
`(2010, pp. 146-147) who found that
“employees clearly react emotionally to their perceptions of being valued and
supported by their organisation and this in turn impacts their physical health”. The
provision of a counselling service was highly regarded by participants at one
workplace explaining how this service enabled them to manage some personal issues
that were affecting them at work. The value of workplace counselling has been
recognised internationally as an effective means of assisting employees to cope with a
physical
environment
management
support for WHP
two-way
communication
flexible work
rewards
personal
relationships
Figure 1.
A health promoting
workplace
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range of psychological, emotional and behavioural problems that may impact on
them at work (Kirk and Brown, 2003; McLeod, 2010).
The organisational culture of the workplace plays a significant role in the uptake
of WHP programmes (Makrides et al., 2007; Goetzel and Ozminkowski, 2008). Good
organisational characteristics are the platform from which workplace health
programmes may be launched. Without factors such as good management support,
good communication and job flexibility, any programmes are likely to suffer from
a lack of interested participants and/or a lack of desired outcomes. The above factors
undoubtedly improve mental health which is the first step to improving peer
relationships, physical health, family relationships, engagement with the wider
community and worker productivity (Russell, 2009).
All employers in our study (even those who provided the most generous amenities
to their staff for the benefit of the employees’ health and wellbeing) maintained
an understandable priority for productivity and their financial bottom line. This is not
at odds with successful WHP. Changes to an organisation which can improve health
do not need to be expensive, and as these results show, the organisation’s productivity
and bottom line benefits through decreased absenteeism and increased staff morale
and work ethic. A report commissioned by the large Australian medical insurer
Medibank Private confirmed these results, finding that the healthiest Australian
workers are three times more productive than the unhealthiest workers (Medibank
Private, 2005). Employees are happy to work hard in a role where they feel respected
and valued. Employers can improve employee health and wellbeing by implementing
or improving:
.Leadership – lead by using good examples and use leaders as mentors and
champions of workplace values and virtues (Russell, 2009).
.Build health and wellbeing into the core daily business – take every opportunity
to improve respect and communication among staff as a part of day to day work
(Ackland et al., 2005).
.Align health promotion initiatives with the organisation’s values – if the
organisation values passion, make the programme fun; if it values teamwork,
make the programme feature a team competition (Black, 2008).
.Design a strategic plan for health promotion and review it annually and allocate
a budget to support the initiatives in the strategic plan (Ackland et al., 2005).
.All employees must get equal opportunities to be involved – don’t exclude
distantly located employees (Ackland et al., 2005).
.Tap into existing public events – national or local community health awareness
campaigns. This encourages participation, is fun, and strengthens links with the
community (Institution of Occupational Safety and Health (IOSH), 2011).
This whole of organisation approach in which health promotion is embedded into the
day to day running of the business is a significant shift from the individual behaviour
change approach currently dominating WHP. Providing a supportive environment
and improving the organisational culture within a workplace are essential first steps
to ensuring the success of WHP programmes. The goals of the programmes should be
to ensure that positive health behaviours become engrained into the culture of an
organisation. For many organisations this requires “a shift in thinking, so that the
interventions are not seen as short-term programmes, but as part of the culture of the
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workplace” (Marshall, 2004, p. 64). In order for this to be achieved it is vital to have
full management support and commitment to the goals of the programme ( Jung
et al., 2011). The European Network for WHP has developed a “healthy organisation
model” which depicts the factors crucial for the success of WHP (Institute of
Occupational Health and Safety (IOSH), 2010). This embedded approach reduces
some of the barriers to participation (lack of time or lack of management support for
programmes) reported in this study. Each of the organisations in this study had
undergone changes due to mergers and/or the global financial crisis. This left many
employees acutely aware of the tenuousness of their positions (having seen colleagues
retrenched) or upset about staff bonus payments being suspended when they were
required to do more work with less staff. It is precisely when employees are feeling this
vulnerable that they most need the reassurance of feeling valued in their role. This can
be achieved reasonably cheaply, and have the potential to swing staff morale from
disillusioned and resentful to encouraged and motivated to work hard for the company.
Simple ideas such as movie tickets as a reward for employee of the week, or a family
picnic day can produce feelings of being valued.
What policy makers can do?
Policy makers must broaden the scope and definition to effectively support the whole
of organisation approach identified in this study. The narrow biomedical individual
behaviour change view is of limited effectiveness in terms of population health as it
does not address the social determinants of health (Ravia and Thomson, 2011).
However, the current work health checks campaign in Victoria (which falls into the
biomedical behaviour change category) has created an awareness of workplace health
and a momentum which it would be prudent to build upon. Mental health is already
acknowledged in Australia and around the world as a significant public health issue
(Department of Health and Ageing, 2008; World Health Organization, 2008).
The role of the workplace in supporting good mental health must be prioritised.
Already Australia has moved to heighten the awareness of bullying and harassment
in the workplace and has bought to account those who transgress through the legal
system, (a toughening of the laws now sees workplace bullying come under the Crimes
Act 1958 rather than the less severe penalties in the Occupational Health and Safety
Act 2004 (Department of Justice, 2012). This system however, is a deficit model
operating on the “what not to do” end of the scale rather than supporting “what to do”
initiatives. As Butterworth and colleagues concluded:
From a policy perspective it is important to recognise that, just as adverse psychosocial job
conditions may lead to poor mental health, it is possible that workplace changes which
improve the quality of one’s job could be an effective strategy to improve population mental
health (Butterworth et al., 2011, p. 570).
Policy makers can support initiatives by employers through the provision of grants to
implement business coaching, leadership training, and health coaching. The former
two initiatives are more readily associated with business psychology but this is the
point – that “health” programmes, to be truly effective, must expand their focus and
associated funding beyond what has traditionally been defined as health. While this
poses challenges to government departments who often operate in isolation from one
another, there is a real need for inter-sectoral collaboration and understanding. An
appreciation is needed by policy makers and funders that organisational change takes
time and that neither tangible initiatives (specific time limited, distinct “programmes”)
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nor measurable (biomedical/physical) health outcomes may be present in the way they
have been traditionally expected and quantified.
Limitations of this study
This study was conducted in three workplaces in regional Victoria in Australia.
The study was not designed to yield a representative sample of all workplaces
or all workers. The researchers acknowledge that there exists a wide variety of
workplaces and working situations not capturedinthissample.Thesamplesizeof
42 interviews is quite large for a qualitative study and the results provide some
unique insights into WHP programmes and how these are viewed by employers
and employees.
Conclusion and recommendations
WHP is the domain of all employers and everyone who works. Good population health,
especially mental and emotional wellbeing, depends upon health promoting working
environments. This study has revealed that health promotion in the workplace is not
only about providing health programmes such as a fitness challenge designed to bring
about individual behaviour change, but rather it is the supportive organisational
culture of a workplace that provides the most benefits to individual workers. To
positively influence health in the workplace a shift in focus is required from individual
or personal behaviour change to a more strategic, comprehensive approach. This
includes a range of multi-strategy interventions but the most important component is
management support and integration of WHP into the organisational structure.
In the cases reported here it was clearly evident that when WHP is embedded into the
culture of a workplace and supported by management on all levels that real health
gains are possible.
Further benefits to the organisations through improved productivity and reduced
absenteeism make the case for implementing change a sound one for employers.
Employers will need guidance and support to make positive changes, especially as many
employers may currently see worker health and wellbeing as not their responsibility
beyond legislative OH&S requirements. It is recommended that workplaces are supported
by policy and government initiatives that enable clear pathways for employers to make
organisational adjustments to enhance the health and well-being of staff and be rewarded
for doing so. Workplaces are uniquely placed to have a positive impact on health and well-
being but need to be supported to make changes to such things as organisational
structures that impact negatively on the employers and employees. Whilst this study has
provided some unique insights into how employers and employees view WHP within
the context of their organisations, further research that documents the many successes in
WHP is warranted.
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About the authors
Dr Virginia Dickson-Swift is a Senior Lecturer and the Head of Department in the Department of
Public & Community Health at the LRHS, Bendigo. Virginia has an interest in health promotion
and public health with a particular focus on the role of workplaces. She teaches across a broad
range of undergraduate and graduate public health programmes and has expertise in a range of
qualitative methodologies for health research. Dr Virginia Dickson-Swift is the corresponding
author and can be contacted at: v.dickson-swift@latrobe.edu.au
Dr Christopher Fox is a Senior Lecturer in Sexual Health Counselling and Therapy.
Christopher previously was a Senior Lecturer in Public Health at the La Trobe Rural Health
School.
Karen Marshall is a Researcher and Casual Academic at the La Trobe Rural Health School.
Karen has an honours Degree in Public Health from the La Trobe University and a special
interest in public health policy. Her research topics have included the HPV vaccine and
workplace health promotion.
Dr Nicky Welch is a Sociologist with a background in public health. She is presently a senior
policy officer at the Victorian State Government Department of Health. Her research interests
include rural health, qualitative methodology, healthy eating and physical activity, workplace
health promotion, and community health promotion.
Dr Jon Willis is an Associate Professor in the Aboriginal and Torres Strait Islander Studies
Unit at the University of Queensland. He has a PhD from the Australian Centre for the
International and Tropical Health and Nutrition, focused on Pitjantjatjara men’s practices of
masculinity and sexual risk. Since the completion of his PhD, he worked as a Lecturer in
Indigenous Health at the University of Queensland (1997-1999), as a Research Fellow and a
Senior Research Fellow at the Australian Research Centre in Sex, Health and Society since July
1999, and as a Senior Lecturer in Public Health at La Trobe University Bendigo from 2007-2012.
To purchase reprints of this article please e-mail: reprints@emeraldinsight.com
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