An Exploratory, Qualitative Study of How Organizations Implement the Hierarchy of Controls Applied to Total Worker Health®.

Understanding of how Total Worker Health® (TWH) guidelines are implemented in employment organizations in the USA is not well understood. The purpose of this study is to explore how the principles of the Hierarchy of Controls Applied to NIOSH Total Worker Health (TWH HoC), have been implemented among organizations featured as Promising Practices for TWH between 2012-2019, with special focus on the work-related issues of fatigue, stress, sedentary work, and tobacco control. We also sought to identify benefits, obstacles, and lessons learned in the implementation of the TWH HoC. Eighteen organizations were identified to be included in the study. Using a qualitative cross-sectional design and purposive sampling, seven in-depth interviews were conducted with thirteen key informants. The Consolidated Framework for Implementation Research was used to guide the thematic analysis and interpretation of qualitative data. Four themes identified include recognition of the TWH approach and TWH HoC, implementation of the TWH HoC, barriers and facilitators in addressing specific work-related issues, and implementation climate primes benefits, obstacles, and lessons learned. The inner setting (i.e., culture, implementation climate, readiness for implementation) of organizations was a prominent determinant of the implementation of integrated worker safety, health, and well-being interventions.

The Perils of Integrating Wellness and Safety and Health and the Possibility of a Worker-Oriented Alternative.

In response to the article by Michael B. Lax, MD entitled "The perils of integrating wellness and safety and health and the possibility of a worker-oriented alternative," the National Institute for Occupational Safety and Health (NIOSH) provides updated information on the current focus and priorities and addresses concerns raised regarding the Total Worker Health® initiative. Many of the concerns and criticisms in the report echo those NIOSH publicly shares on a regular basis. The theory and practice of Total Worker Health (TWH) continues to evolve in response to valuable stakeholder input like that provided by Dr. Lax. In 2015, NIOSH updated the TWH concept to emphasize the main focus of TWH is the primacy of traditional health protection which prioritizes employer responsibilities for the organization of work over individual worker health behaviors. NIOSH acknowledges the past lack of "fit" between theory and practice in some publications of TWH-funded grantees as Dr. Lax points out. NIOSH is hopeful that the solicitation of new research, which is now underway, will clarify the work-centered priorities for TWH-funded research. Based on input from Dr. Lax and other stakeholders, NIOSH looks forward to contributing more effectively to protecting and promoting worker safety and health in the new twenty-first century world of work.