The effects of a Total Worker Health intervention on workplace safety: Mediating effects of sleep and supervisor support for sleep.

We tested the effects of a randomized controlled trial Total Worker Health intervention on workplace safety outcomes. The intervention targeted employee sleep at both the supervisor-level (e.g., sleep-specific support training) and employee-level (e.g., sleep tracking and individualized sleep feedback). The intervention components were developed using principles of the Total Worker Health approach and the theory of triadic influence for health behaviors. We hypothesized that employees in the treatment group would report greater safety compliance, safety participation, and safety motivation, and would be less likely to experience a work-related accident or injury following the intervention through improvements in sleep quantity and quality, as well as increased perceptions of supervisors' support for sleep. It was theorized that the indirect effects of the intervention on workplace safety outcomes via sleep mediators operated through a resource pathway, whereas the supervisor support for sleep mediator operated through an exchange pathway. Results broadly revealed that employees in the treatment group, compared to those in the control group, reported greater workplace safety behaviors and safety motivation, and reduced workplace accidents and injuries 9 months post-baseline, through lower dissatisfaction with sleep, reduced sleep-related impairments, and greater supervisor support for sleep 4 months post-baseline. Intervening on sleep and supervisor support for sleep in an integrated Total Worker Health framework can have a positive impact on workplace safety. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of a Total Worker Health® leadership intervention on employee well-being and functional impairment.

Although evidence has been mounting that supervisor support training interventions promote employee job, health, and well-being outcomes, there is little understanding of the mechanisms by which such interventions operate (e.g., Hammer et al., 2022; Inceoglu et al., 2018), nor about the integration of such organizational-level interventions with individual-level interventions (e.g., Lamontagne et al., 2007). Thus, the present study attempts to unpack the mechanisms through which supervisor support training interventions operate. In addition, the present study examines an integrated Total Worker Health® intervention that combines health protection in the form of supervisor support training (i.e., family supportive supervisor behaviors and supervisor support for sleep health) with a health promotion approach in the form of feedback to improve sleep health behaviors. Using a cluster randomized controlled trial drawing on a sample of 704 full-time employees, results demonstrate that the Total Worker Health intervention improves employee job well-being (i.e., increased job satisfaction and reduced turnover intentions), personal well-being (i.e., reduced stress before bedtime), and reduces personal and social functional impairment at 9 months postbaseline through employee reports of supervisors' support for sleep at 4 months postbaseline, but not through family supportive supervisor behaviors. Effects were not found for general stress or occupational functional impairment outcomes. Implications are discussed, including theoretical mechanisms by which leadership interventions affect employees, supervisor training, as well as the role of integrated organizational and individual-level interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The relationship between leadership support and employee sleep.

Sleep is critical to employees' health and well-being, safety, and performance at work. Sleep leadership refers to supervisor behaviors that aim to improve employees' sleep, such as showing concern for the quantity and quality of employees' sleep. Using a sample of 180 employees and their 91 supervisors working as full-time National Guard military service members, we examined the relationship of sleep leadership and family-supportive supervisor behaviors (FSSB) to employees' sleep. As outcomes we measured objective sleep quality and quantity using validated wrist actigraphy methods, as well as self-reported sleep hygiene, subjective sleep quantity, and subjective sleep quality (sleep disturbance and sleep-related impairment). As a novel contribution to the literature, we included both supervisors' self-reports and employees' reports of supervisors' engagement in sleep leadership and FSSB. Contradicting our hypotheses, our results show that higher employee ratings of FSSB were related to shorter objective sleep time. Regarding self-reported sleep outcomes, higher employees' ratings of sleep leadership were associated with less sleep disturbance and less sleep-related impairment among employees. Higher supervisors' self-ratings of FSSB, in turn, were related to better sleep hygiene and less sleep-related impairment among employees. Overall, our study demonstrates the importance of supportive supervisor behaviors for employees' sleep quality. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Supervisor support training effects on veteran health and work outcomes in the civilian workplace.

This randomized controlled trial involved the development and evaluation of a supervisor support training intervention in the civilian workforce called VSST: Veteran-Supportive Supervisor Training. A theoretically based intervention in the workplace is critical to ensuring a smooth transition for service members and their families to civilian life, leading to improved psychological and physical health and improved work outcomes among service members. Thirty-five organizations were recruited and randomized to the VSST training program or a waitlist control group. Within those organizations, 497 current or former (post 9/11) service member employees were asked to complete baseline and 3- and 9-month follow-up surveys covering work, family, and health domains. The computerized 1-hr training, and the behavior tracking that followed were completed by 928 supervisors from the participating organizations. Intervention training effects were evaluated using an intent-to-treat approach, comparing outcomes for service members who were in organizations assigned to the training group versus those who were in organizations assigned to the control group. Moderation effects revealed the intervention was effective for employees who reported higher levels of supervisor and coworker support at baseline, demonstrating the importance of the organizational context and trainee readiness. The results did not show evidence of direct effects of the intervention on health and work outcomes. Qualitative data from supervisors who took the training also demonstrated the benefits of the training. This study affirms and adds to the literature on the positive effects of organizational programs that train supervisors to provide social support, thereby improving health and work outcomes of employees who receive more support. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Cost and Return on Investment of a Work-Family Intervention in the Extended Care Industry: Evidence From the Work, Family, and Health Network.

OBJECTIVE: To estimate the cost and return on investment (ROI) of an intervention targeting work-family conflict (WFC) in the extended care industry. METHODS: Costs to deliver the intervention during a group-randomized controlled trial were estimated, and data on organizational costs-presenteeism, health care costs, voluntary termination, and sick time-were collected from interviews and administrative data. Generalized linear models were used to estimate the intervention's impact on organizational costs. Combined, these results produced ROI estimates. A cluster-robust confidence interval (CI) was estimated around the ROI estimate. RESULTS: The per-participant cost of the intervention was $767. The ROI was -1.54 (95% CI: -4.31 to 2.18). The intervention was associated with a $668 reduction in health care costs (P < 0.05). CONCLUSIONS: This paper builds upon and expands prior ROI estimation methods to a new setting.

Costs of a work-family intervention: evidence from the work, family, and health network.

PURPOSE: To estimate the cost to the workplace of implementing initiatives to reduce work-family conflict. DESIGN: Prospective cost analysis conducted alongside a group-randomized multisite controlled experimental study, using a microcosting approach. SETTING: An information technology firm. SUBJECTS: Employees (n = 1004) and managers (n = 141) randomized to the intervention arm. INTERVENTION: STAR (Start. Transform. Achieve. Results.) to enhance employees' control over their work time, increase supervisor support for employees to manage work and family responsibilities, and reorient the culture toward results. MEASURES: A taxonomy of activities related to customization, start-up, and implementation was developed. Resource use and unit costs were estimated for each activity, excluding research-related activities. ANALYSIS: Economic costing approach (accounting and opportunity costs). Sensitivity analyses on intervention costs. RESULTS: The total cost of STAR was $709,654, of which $389,717 was labor costs and $319,937 nonlabor costs (including $313,877 for intervention contract). The cost per employee participation in the intervention was $340 (95% confidence interval: $330-$351); $597 ($561-$634) for managers and $300 ($292-$308) for other employees (2011 prices). CONCLUSION: A detailed activity costing approach allows for more accurate cost estimates and identifies key drivers of cost. The key cost driver was employees' time spent on receiving the intervention. Ignoring this cost, which is usual in studies that cost workplace interventions, would seriously underestimate the cost of a workplace initiative.

A longitudinal study of the effects of dual-earner couples' utilization of family-friendly workplace supports on work and family outcomes.

Little research exists on the effects of the utilization of workplace supports on work-family conflict and job satisfaction. With family systems theory as a framework, 2 waves of national survey data were collected from 234 couples (N = 468) caring for children and for aging parents. Data were analyzed with structural equation modeling techniques. Longitudinal results indicate that individuals' use of workplace supports was related to work-family conflict in the direction opposite to expectations and was related to job satisfaction in the direction consistent with expectations. Differential effects for wives versus husbands were found. In addition, couples' use of workplace supports was only minimally related to wives' outcomes. Results are discussed in terms of gender differences, family systems theory, and methodological and measurement issues related to the longitudinal study of utilization of workplace supports.

Using existing population-based data sets to measure the American Academy of Pediatrics definition of medical home for all children and children with special health care needs.

OBJECTIVE: National health goals include ensuring that all children have a medical home. Historically, medical home has been determined by the presence of a usual or primary source of care, such as a pediatrician or a family physician. More recent definitions expand on this simplistic notion of medical home. A definition of medical home set forth by the American Academy of Pediatrics (AAP) includes 7 dimensions and 37 discrete concepts for determining the presence of a medical home for a child. Standardized methods to operationalize these definitions for purposes of national, state, health plan, or medical practice level reporting on the presence of medical homes for children are essential to assessing and improving health care system performance in this area. The objective of this study was to identify methods to measure the presence of medical homes for all children and for children with special health care needs (CSHCN) using existing population-based data sets. METHODS: Methods were developed for using existing population-based data sets to assess the presence of medical homes, as defined by the AAP, for children with and without special health care needs. Data sets evaluated included the National Survey of Children With Special Health Care Needs, the National Medical Expenditures Panel Survey, the Consumer Assessment of Health Plans Study Child Survey (CAHPS), and the Consumer Assessment of Health Plans Study Child Survey--Children With Chronic Conditions (CAHPS-CCC2.0H). Alternative methods for constructing measures using existing data were compared and results used to inform the design of a new method for use in the upcoming National Survey of Children's Health. Data from CAHPS-CCC2.0H are used to illustrate measurement options and variations in the overall presence of medical homes for children across managed health care plans as well as to evaluate in which areas of the AAP definition of medical home improvements may be most needed for all CSHCN. RESULTS: Existing surveys vary in their coverage of concepts included in the AAP definition of medical home and, therefore, in their capacity to evaluate medical home for children with and without special health care needs. Using data from CAHPS-CCC2.0H, the overall proportion of children who were enrolled in managed care health plans and met criteria for having a medical home varied from 43.9% to 74% depending on the specific scoring method selected for these items. Wide variations across health plans were observed and were most prominent in the areas of "accessible care" and "comprehensive care." Performance was uniformly poorest in the area of "coordinated care" and for CSHCN. Although children with a personal doctor or nurse were more likely to meet the AAP criteria for having a medical home, simply having a personal doctor or nurse was not highly predictive of whether a child experienced the other core qualities of a medical home (positive predictive value: .50; negative predictive value: .59). CONCLUSIONS: Despite differences across existing surveys and gaps in concepts represented, we believe that the AAP definition of medical home can be well represented by the small subset of concepts represented in the National Survey of Children With Special Health Care Needs and the CAHPS-CCC2.0H. A less comprehensive yet still worthwhile measure is possible using the Medical Expenditures Panel Survey. The varying degrees of empirical evidence and consensus for each of the AAP definition domains for medical home suggest the need for constructing measures that also vary in terms of criteria for determining that a child does or does not have a medical home. In addition to a simple "yes or no," or rate-based, measure, a continuous medical "homeness" score that places a child or group of children on a continuum of medical "homeness" is also valuable. Findings indicate that health plans have an important role to play in ensuring medical homes for children in addition to medical practices and those who set policies that guide the design and delivery of health care for children. Oven. Overall, using existing population-based data, a measure of medical home that is aligned with the AAP definition is feasible to include in the annual National Healthcare Quality Report, in state reports on the quality of Medicaid, State Children's Health Insurance Program, and Title V programs as well as to evaluate performance on the Healthy People 2010 objectives and the President's New Freedom Initiative.