the state of the art in workplace audits with thomas golaszewski
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HEcheck: A Workplace
Health Environment Assessment
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Provide a rationale for organizational assessment and intervention
Review the Heart Check odyssey Introduce the new organizational
assessment: HEcheck
Demonstrate HEcheck assessment and reporting capabilities
Discuss the future of organizational assessments
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Are systems-based models Explain behavior as the interrelationship of
organisms and their environments
*Salis & Owen, Ecological Models of Health Behavior, In:
Glanz et al, Health Behavior & Health Education, 2002.
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Adapted from: http://www.carbc.ca/HelpingCommunities.aspx
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“People will change behavior to reflect their environments. Therefore, if you want healthy people, simply create healthy environments.”
Thomas Golaszewski
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Grew out of NYS Department of Health’s “Healthy Heart Program” – Mid 1990s
Application of Social Ecology principles
Research Question: How do you create healthy workplace environments?
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“You can’t manage IT unless you can measure IT.”
Peter Drucker, Ph.D. (?)
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Assessment for organizational support for employee heart health (structure): policies, services and facilities; and program administration
226 items scored as a dichotomy: 0 or +1 Contains sections on: organizational
foundations, administrative support, tobacco, nutrition, physical activity, stress, screening
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-20
0
20
40
60
80
100
120
140
160
180
200
Smoking Nutrition Phys Act Screen Adm Sup Total
Experimental
Control
Golaszewski et al. (1998). An Organization-based Intervention to Improve Support for Employee Heart, Am J Health Promotion.
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$2,098
$4,530
$5,813
$7,123
$4,401
$3,216
$1,550
$2,667
$3,364
$4,718
$3,069
$2,480
$1,351 $2,110
$2,912
$3,894
$2,605 $2,200
$1,122$1,523 $2,081
$2,941
$1,851 $1,641
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
19-34 35-44 45-54 55-64 65-74 75+
Costs Associated with Risks Medical Paid Amount x Age x Risk
Low Risk
Medium Risk
High Risk
Non - - Participant
Edington. AJHP. 15(5):341-349, 2001
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THE HEART CHECK HEALTH PROMOTION MATRIX December 2004
Organizational Foundations: This section describes compensation and human resource management elements that indirectly support employee health. Although very
important, they are not usually under the auspices of the health promotion agenda and are therefore listed separately. 9.1.1, 9.1.2, 9.1.3, 9.2.1, 9.2.2, 9.2.3, 9.3.1, 9.3.2, 9.4.1, 9.4.2, 9.5.1, 9.6.1, 9.7.1, 9.7.2, 9.7.3, 9.7.4, 9.8.1, 9.8.2
Smoking
Nutrition
Physical Activity
Stress
Screening
Administrative
Support
Implementation Level
8.1 8.2 8.6.1 8.11.1
8.1.1 8.6.3 8.11.2
8.1.2 8.5 8.6.4
8.1.3 8.5.3 8.6.5
8.1.4 8.5.4 8.6.6
8.1.5 8.5.5 8.6.7
8.5.6 8.6.8
1. Start-up: Structural development, “must do”
beginning activities, no service
delivery.
3.1.1a 3.4.1
3.1.1b 3.5.1
3.1.1c
3.1.2
3.1.3
3.1.4
4.1.1 4.5.1
4.1.2 4.5.2
4.2.1
4.2.2
4.2.3
5.3.1 5.7
5.3.3
5.3.4 5.8
5.3.6
6.2.2 6.7.1
6.7.2
6.5 6.7.3
6.5.1
6.5.2
6.5.3
8.1.7
8.9
8.10.1
2. Policy/Environment
Enhancement: Easy policy changes or logical
continuations of the above. Sets up
service delivery.
3.2.1
3.3.11
3.3.1
3.3.4
3.3.6
4.1.3 4.4.1
4.4.2
4.2.4 4.4.3
4.4.4
4.3.1 4.4.6
4.3.2 4.4.10
4.3.4
4.3.6 4.6.1
4.3.10
5.4.1 5.9.1 5.10
5.4.2
5.4.4 5.11
5.4.5 5.11.1
5.4.9 5.11.2
6.3.1 6.4
6.3.2
6.3.4 6.8
6.3.6
6.3.10
7.1 7.4
7.1.1 7.4.1
7.1.3 7.4.4
7.6.1
8.7.1
8.8.1
8.12
3. Beginning Service Delivery: Information and awareness building
activities, relatively inexpensive
programming.
3.3.2 3.3.9
3.3.3 3.3.10
3.3.5 3.3.12
3.3.7
3.3.8
3.3.9
3.3.8
3.3.9
4.3.3 4.4.5
4.3.5 4.4.7
4.3.7 4.4.8
4.3.8 4.4.9
4.3.9 4.4.11
4.3.11
5.4.3 5.5 5.6
5.4.6 5.5.1 5.6.1
5.4.7 5.5.2 5.6.2
5.4.8 5.5.3 5.6.3
5.4.10 5.5.4 5.6.4
5.5.5 5.6.5
5.6.6
5.6.7
6.1.1 6.3.3
6.1.2 6.3.5
6.1.3 6.3.7
6.1.4 6.3.8
6.3.9
6.2.1 6.3.11
7.1.2 7.2 7.3
7.1.4 7.2.1 7.3.1
7.1.5 7.2.2 7.3.2
7.2.3 7.3.3
7.4.2 7.2.4 7.3.4
7.4.3 7.2.5 7.3.5
8.3 8.7.2
8.7.4
8.4
8.4.1 8.8.2
8.4.2 8.8.3
8.4.3
4. Advanced Service Delivery: More expensive and intrusive than the
above, broadened service delivery.
3.2.2
5.1 5.2 5.3.2
5.1.1 5.2.1 5.3.5
5.1.2 5.2.2
5.1.3 5.2.3
5.1.4 5.2.4 5.9.2
5.2.5
5.2.6
6.6
6.6.1
6.6.2
6.6.3
6.6.4
7.5
7.5.1
7.5.2
7.5.3
8.1.6 8.7.3 813.1
8.13.2
8.5.1 8.10.2 8.13.3
8.5.2
8.6.2
5. Institutionalization: Advanced policy development,
relatively expensive, high capital
costs, long term cultural change.
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THE HEART CHECK HEALTH PROMOTION MATRIX November 2006
Organizational Foundations: This section describes compensation and human resource management elements that indirectly support employee health. Although very
important, they are not usually under the auspices of the health promotion agenda and are therefore listed separately. 9.1.1, 9.1.2, 9.1.3, 9.2.1, 9.2.2, 9.2.3, 9.3.1, 9.3.2, 9.4.1, 9.4.2, 9.5.1, 9.6.1, 9.7.1, 9.7.2, 9.7.3, 9.7.4, 9.8.1, 9.8.2
Smoking
Nutrition
Physical Activity
Stress
Screening
Administrative
Support
Implementation Level
8.1 8.2 8.6.1 8.11.1
8.1.1 8.6.3 8.11.2
8.1.2 8.5 8.6.4
8.1.3 8.5.3 8.6.5
8.1.4 8.5.4 8.6.6
8.1.5 8.5.5 8.6.7
8.5.6 8.6.8
1. Start-up: Structural development, “must do”
beginning activities, no service
delivery.
3.1.1a 3.4.1
3.1.1b 3.5.1
3.1.1c
3.1.2
3.1.3
3.1.4
4.1.1 4.5.1
4.1.2 4.5.2
4.2.1
4.2.2
4.2.3
5.3.1 5.7
5.3.3
5.3.4 5.8
5.3.6
6.2.2 6.7.1
6.7.2
6.5 6.7.3
6.5.1
6.5.2
6.5.3
8.1.7
8.9
8.10.1
2. Policy/Environment
Enhancement: Easy policy changes or logical
continuations of the above. Sets up
service delivery.
3.2.1 3.3.11
3.3.1
3.34
3.36
4.1.3 4.4.1
4.4.2
4.2.4 4.4.3
4.4.4
4.3.1 4.4.6
4.3.2 4.4.10
4.3.4
4.3.6 4.6.1
4.3.10
5.4.1 5.9.1 5.10
5.4.2
5.4.4 5.11
5.4.5 5.11.1
5.4.9 5.11.2
6.3.1 6.4
6.3.2
6.3.4 6.8
6.3.6
6.3.10
7.1 7.4
7.1.1 7.4.1
7.1.3 7.4.4
7.6.1
8.7.1
8.8.1
8.12
3. Beginning Service Delivery: Information and awareness building
activities, relatively inexpensive
programming.
3.3.2 3.3.9
3.3.3 3.3.10
3.3.5 3.3.12
3.3.7
3.3.8
4.3.3 4.4.5
4.3.5 4.4.7
4.3.7 4.4.8
4.3.8 4.4.9
4.3.9 4.4.11
4.3.11
5.4.3 5.5 5.6
5.4.6 5.5.1 5.6.1
5.4.7 5.5.2 5.6.2
5.4.8 5.5.3 5.6.3
5.4.10 5.5.4 5.6.4
5.5.5 5.6.5
5.6.6
5.6.7
6.1.1 6.3.3
6.1.2 6.3.5
6.1.3 6.3.7
6.1.4 6.3.8
6.3.9
6.2.1 6.3.11
7.1.2 7.2 7.3
7.1.4 7.2.1 7.3.1
7.1.5 7.2.2 7.3.2
7.2.3 7.3.3
7.4.2 7.2.4 7.3.4
7.4.3 7.2.5 7.3.5
8.3 8.7.2
8.7.4
8.4
8.4.1 8.8.2
8.4.2 8.8.3
8.4.3
4. Advanced Service Delivery: More expensive and intrusive than the
above, broadened service delivery.
3.2.2
5.1 5.2 5.3.2
5.1.1 5.2.1 5.3.5
5.1.2 5.2.2
5.1.3 5.2.3
5.1.4 5.2.4 5.9.2
5.2.5
5.2.6
6.6
6.6.1
6.6.2
6.6.3
6.6.4
7.5
7.5.1
7.5.2
7.5.3
8.1.6 8.7.3 813.1
8.13.2
8.5.1 8.10.2 8.13.3
8.5.2
8.6.2
5. Institutionalization: Advanced policy development,
relatively expensive, high capital
costs, long term cultural change.
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Risk 2005 2007 Difference
Safety Belt Use 9.0% 5.4% -3.6%*
Medication for Relaxation 27.1% 23.9% -3.2%
Physical Inactivity 18.5% 15.9% -2.6%
Smoking 9.8% 7.6% -2.2%
Illness Days 30.1% 28.3% -1.8%
Life Dissatisfaction 25.2% 23.9% -1.3%
Perceived Health 17.6% 16.60% -1.0%
Health Age Index 1.9% 0.9% -1.0%
Disease 13.9% 13.1% -0.8%
Alcohol 2.0% 1.3% -0.7%
**Also a significant decrease in recorded absenteeism.
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Organizational health support (OHS) can be measured reliably and accurately.
Relationships exist between OHS measures and employee health risks, health culture, absenteeism, and selected health care costs.
OHS can be improved relatively easily and cost effectively.
Employee health risk profiles stabilize with organization-focused intervention.
Most OHS variables remain following intervention.
OHS tools can be integrated within a comprehensive worksite health promotion intervention
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Contextual Work Features (Organizational Leadership, industry type,)
(management style, profitability, etc.)
Worksite Worksite Structure Culture
Golaszewski et al. (2008). Working Together to Create Supportive Environments
in Worksite Health Promotion, The Art of Health Promotion.
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Recommendations… Develop new tools based on the latest standards
of excellence in WHP Consider alternate item construction Add organizational health culture Refine automated systems accessible on the
Internet Develop detailed summary reports
Golaszewski, in:Pronk (Ed.). 2009. ACSM’s Worksite Health
Handbook.
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An assessment process of the workplace’s HEALTH ENVIRONMENT that supports employee health.
Online capability 3 dimensions, 9 sections, 47 constructs and
227 items (variable weights) Within dimension/section/construct
scoring And more…
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3. Medical Management
2. Risk Management
1. Foundations
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Medical Management
Psychosocial
Tobacco Control
Nutrition
Physical Activity
Screening
Culture Change
Commitment
Human Resources Management
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Assessment Awareness Services Structural Supports Policy Supports
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To the online HEcheck…
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Expand research activity at the company-level Establish norms for geographic region, health
plan groups, industry type, or other company demographic
Link organizational rewards to high scoring companies, e.g., provide award recognitions, premium discounts or rate “lock ins”
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