Top 10 Pillars of Total Worker Health
Blog | September 20th, 2023

Top 10 Pillars of Total Worker Health

Novelis Inc., an industrial aluminum company that has manufacturing facilities on four continents, is running a pilot of the Total Worker Health (TWH) approach. It is a methodology recommended by the National Institute for Occupational Safety and Health (NIOSH) to eliminate workplace accidents and improve worker health, safety, and well-being. The company already has health and safety systems in place and the TWH is expected to enhance its effectiveness.

Pillars of Total Worker Health

The company implemented a global screening and assessment process to identify gaps and spot opportunities to improve health and safety management across the entire organization. The four focus areas for the company that emerged from the assessment were:

  • Policy
  • Safety
  • Occupational health
  • Health promotion

As the pilot enabled the company to achieve its goals, it has now integrated TWH as part of its 5-year Environmental, Health, and Safety (EHS) Roadmap.

What is Total Worker Health (TWH)?

The Total Worker Health (TWH) program builds on existing health and safety initiatives through integrated interventions to improve worker safety, health, and well-being. It moves away from the traditional occupational safety and health management programs focused primarily on workplace safety to include social factors such as

  • Wages
  • Work hours
  • Workload
  • Workplace interactions with coworkers and supervisors
  • Access to paid leave

These factors have a larger impact, affecting families and the communities of the workers as well. Therefore, TWH recommends the establishment of a robust safety culture where worker safety and health are addressed through specific interventions, policies, and practices.

To enable this, organizations need to be committed, assess challenges and gaps in the existing approach, and implement changes to the environment and policies to design meaningful programs. While it may be driven from the top, it must be participatory – empowering workers to provide feedback and inputs that will help achieve TWH goals.

Worker well-being is the core focus of TWH, which enables the informed designing of workplaces and worksites such that the physical and psychological health of the workers is ensured.

CDC/NIOSH research also shows that implementing TWH can help businesses and communities lower the cost and impact of injuries and illnesses and minimize disruption to family and community life. A well-designed and implemented TWH enhances worker creativity, productivity, and innovation, making work fulfilling and improving work-life balance. The business also benefits from an improved brand reputation, competitive advantage, employee recruitment and retention, and a sustainable workforce culture.

Some of the findings of the research include:

  • At the end of 4 years of TWH, L.L. Bean, an outdoor clothing, shoe, and equipment company, reported savings of $1.70 to $5.30 for every dollar invested.
  • Workers from a cross-section of industries were studied to assess the impact of time-flexible work policies. Some of the benefits recorded include
    • Increased worker loyalty
    • Less stress
    • Lower costs to incurred missed work or deadlines
  • Access to paid sick leave led to a 28% reduction in nonfatal occupational injuries and saved between $0.63 and $1.88 billion for the employers
  • Where workers have access to supportive supervision, they reported less pain, sufficient sleep, and a lower risk of cardiovascular disease due to lower job insecurity
  • Similar health benefits were reported in the case of workers who had access to support for work-family needs. In addition, the children in such families also had better sleep, and health, and work-family conflict decreased

The 10 Pillars to Focus on When Implementing Total Worker Health (TWH)

Pillar #1 - Hazard-Assessment and Mitigation: The fundamentals of health and safety management must be strong and implemented correctly to make the workplace safe. This includes identifying, assessing, and mitigating high-risk hazards, capturing trends, and implementing controls. This is a must for any organization wanting to adopt Total Worker Health as these are the building blocks that need to be in place for TWH to be successfully implemented.

Pillar #2 - Identify Gaps: The TWH must be designed to address any gaps in worker health and safety to provide the desired outcomes. This must be data-driven, providing insights into what is missing and enabling further analysis to identify the right controls and measures to minimize those gaps.

Pillar #3 - Employee Training: Although TWH is for the employers, it also needs the total involvement of the employees to be successful. Therefore, it is essential to ensure they are aware of what health and safety and TWH are. If required, they must be provided with training and education on what it involves and how it will impact their work. This will help in aligning their tasks and behavior to the TWH goals better. If worker skill is the gap area, then they must also be given training to do their jobs better and with greater safety and efficiency.

Pillar #4 -Top Management Commitment: Leadership commitment is crucial in reassuring workers that their health and safety do matter. This should be demonstrated through words and actions to inspire and motivate workers to be equally committed to the TWH initiative. Ensuring the policies and SOPs are clearly defined, implemented, tracked, and reviewed periodically, and corrective actions are taken or improvements done periodically must be part of the management’s responsibilities. that endorse safety and health in your workplace, consider the extent to which your organization’s spoken and unspoken beliefs and values either support or deter worker well-being. Building accountability and rewarding success to reinforce safe behavior is key here. Encouraging employee participation in program design and development will also improve its effectiveness.

Pillar #5 - Use the Hierarchy of Controls Principle to Prevent Hazards: A Total Worker Health approach stresses a hazard-free work environment by using a proactive, preventative approach using the traditional Hierarchy of Controls principle to ensure occupational safety and health. Under this principle, the first step is to eliminate hazards. Where it is not possible, introduce policies and programs that enhance the safety culture in the workplace. The third stage is to redesign the work environment, where needed, for safety, health, and wellbeing, followed by the removal of impediments, enhancing employer-sponsored benefits, and providing flexible work schedules. Safety and health education and providing resources to empower employees with the knowledge and skills form the fourth step. Finally, the aim must be to help workers make healthier.


Pillar #6 - Encourage Worker Participation: Workers and their supervisors are the best source of insights into their worksites as they deal with hazards and challenges on an ongoing basis. Taking their inputs and incorporating them in TWH design will increase their sense of ownership and willingness to implement it wholeheartedly. This will also improve compliance and outcomes.

Pillar #7 - Be Compliant and Ensure Data Protection: Ensure the TWH program is compliant with the local, national, and global regulatory standards, protects privacy and confidentiality, and provides only authorized personnel with access to sensitive safety and health information. Identify security risks and put in sufficient controls and measures to mitigate the risk of abuse and misuse.

Pillar #8 - Use an Integrated Approach: A unified view of all processes and sites is critical to providing a holistic safety program. Therefore, ensure all systems are integrated and there is real-time visibility into data. This will help with analyzing historical data to capture trends and develop a proactive approach to mitigating risks. It will also help with identifying immediate risks and taking timely action.

Pillar #9 - Review and Monitor Progress: The success of any program can be measured only when it is monitored and tracked. Identify and establish key performance indicators, monitor impact periodically, and take corrective action in case of any gaps. Track both leading and lagging indicators and correct any gaps. Also, benchmark against industry standards.

Pillar #10 - Effect Continuous Improvement: Workplace safety is not a one-time activity. TWH must be an ongoing process. Like in all effective management practices, the PDCA approach is crucial where the safety programs are constantly assessed to identify new areas of vulnerability and implement appropriate corrective and mitigation measures. As the organization expands and the regulatory and business environment changes, new hazards or benchmarks may emerge, necessitating a review and improvement.

Using a cloud-based safety management system such as CQ SafetyQuest can help businesses access data, gather insights, and empower employees with tools to report and proactively participate in TWH.

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