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22016©HERO.Allrightsreserved.
Health Enhancement Research Organization
Culture of Health Study Committee
DEFINING A CULTURE OF HEALTH KEY ELEMENTS THAT INFLUENCE EMPLOYEE HEALTH AND WELL-BEING
…………………………………………………………………………….……………………………………………
SEPTEMBER 2016
2016©HERO.Allrightsreserved. 33
TheHealthEnhancementResearchOrganization(HERO)isanationalnon-profitdedicatedtoidentifyingandsharingbestpracticesinthefieldofworkplacehealthandwell-being(HWB)toimprovetheHWBofworkers,theirspouses,dependents,andretirees.HERO’svisionisthatallworkplaceswillpositivelyinfluencetheHWBofemployees,families,andcommunities.TheCultureofHealth(CoH)StudyCommitteewascreatedtostudyandestablishadefinitionfora“cultureofhealth,”aswellaskeyelementsthatinfluenceandshapeacultureofhealth(CoH).Thecommitteeiscomprisedofacross-functionalgroupof21practitionersandresearchers.Becauseofthebreadthandcomplexityofthework,threeworkgroupswereformedtoaddress(1)Definitions;(2)Research;and(3)Value.ThisreportrepresentsphaseoneoftheongoingeffortsoftheCoHstudycommittee,whichfocusedonestablishingadefinitionfor“cultureofhealth”andidentifyingthekeyelementsinvolvedwithcreatingaCoHwithinanorganization.DevelopmentofThisReportThisreportisaproductoftheDefinitionsWorkgroupoftheHEROCoHStudyCommittee,whichincludes42subjectmatterexperts,practitioners,andresearchersworkingwithinthisarea.DevelopmentofthisreportwasledbyHEROstaffandmembersoftheDefinitionsWorkgroup,withcontributionsbymembersofthelargerCoHstudycommittee.Developersofthisreportinclude:
• JuddAllen,PhD,HumanResourcesInstitute• RalphColao,HEROStudyCommitteeCo-Chair• JenniferFlynn,MS,Mayo• SueGrauer,RN,BSN,Aetna• JessicaGrossmeier,PhD,MPH,HERO• DanKrick,HexagonandCoHDefinitionsWorkgroupLeader• TinaLankford,CDC• DyannMatsonKoffman,CDC• KarenMoseley,HERO• MarkPoindexter,ShellOilCo.• KimSilbaugh,LockheedMartinCorporation• PaulTerry,HERO• JoniTroester,MBA,CEBS,UniversityofIowaFormoreinformation,contactHEROat:HealthEnhancementResearchOrganization7400MetroBoulevard,Suite270Edina,MN55439952-835-4257|info@hero-health.org|hero-health.org
42016©HERO.Allrightsreserved.
INTRODUCTIONANDMETHODS
Practitionersandresearchersagreethatacultureexistsineveryorganizationwhetheror
notitwascreatedintentionally.Designingculturewithintentiskeyincreatingand
sustainingahealthyworkplaceculture.However,aclearvisionanddefinitionofcultureis
essentialtothatintention.
HEROlaunchedtheCultureofHealth(CoH)studycommitteein2013toestablishawidely
accepteddefinitionofCoH,includingalistofelementsandassociatedindicators,which
accuratelydescribesaculturethatsupportsthehealthandwell-beingofanemployer
population.Tobeginworktowardsthischarter,aWorkgroupwasformedtofocusonthe
developmentofaconsensusdefinitionandelements.
TheWorkgroupmetregularlyviateleconferenceforaperiodof10monthstodevelopa
definitionandthenidentifytheelementsofculture.Thefinalproposeddefinition,which
wasacceptedbythebroaderCoHstudycommittee,was:“Ahealthyworkplacecultureisone
intentionallydesignedwithelementsthatsupporthealthandwell-being.”
Oncethedefinitionwasagreedupon,workbeganontheseconddeliverableofidentifying
thekeyelementsinvolvedwithcreatingaCoHwithinanorganization.Theprocessof
identifyingelementscommencedwiththesubcommitteechairaskingeveryoneonthe
committeetosharewiththeWorkgrouptheelementstheybelievedarekeyinfluencersfor
creatingandsustainingaCoH.Theinitiallistwaswellover50elements.Avotingprocess
wasusedtohelpprioritizethediscussionofeachelementanditwasdeterminedthatfor
eachelement,theWorkgroupwouldcreatethefollowing:
1. Theelementdefinedinabroadsense(anorganizationaldevelopmentdescriptionor
strategiclevel)
2. Theelementdefinedinanoperationaldefinition,i.e.,thiselementspecificallyapplied
forthepurposeofcreatingahealthyworkplaceculture
3. Examplesthatrepresentvisiblebehaviorsorindicatorswithinahealthyculture
52016©HERO.Allrightsreserved.
TheWorkgroupleaderfacilitatedaconsensusdecision-makingprocess.Theprocess
allowedforhealthydebateandchallenge,butultimatelywesoughtconsensusevenifthat
meantanindividualhadto“give”onaparticularpointwhenthebroadergroupsupporteda
differentvieworperspective.Workgroupmembersreferencedhealthycultureassessments,
casestudies,approaches,andpracticalexperiencetoidentifyhealthycultureelements.A
finallistof24elementswereidentifiedanddefined.Thesewerereviewed,modified,and
thenapprovedbytheentireCoHstudycommittee.
Asafinalstep,allHEROThinkTankmemberswereaskedtoparticipateinasurveyrelated
totheidentifiedelements.Foreachelement,memberswereaskedhowfrequentlythey
applytheelementincreatingahealthycultureandtheimpactoftheelementincreatinga
healthyculture.ThesurveywasconductedtoassisttheResearchWorkgroupinprioritizing
theirworkaswellasgathersomeinitialdataontheperceivedstrengthofeachelementas
aninfluenceronanorganization’sCoH.Thesurveyrevealedthatcertainelementswere
perceivedtohaveamuchhigherimpactthanothers.
ELEMENTSOFCULTURE
Thefulllistofthe24KeyElementsofaCoHaswellasapplicabledefinitionsandexamples
areprovidedintheTableattheendofthisreport.Notethattheyarenotpresentedinorder
ofpriorityorimportancebasedonthesurveybecausetheWorkgroupfelttheyshouldnot
berankorderedwithoutsupportingevidencefromtheResearchWorkgroup.
CONCLUSION
WeclosewithaninterestingperspectivesharedbytheDefinitionsWorkgroupthatwas
revealedinthecourseoftheirwork.Althoughthese24KeyElementswerediscussedand
detailedwithspecificexamplesforcreatingaculturethatsupportshealthandwell-being,it
shouldbenotedthatthesesameelements,withintentionaldesigncanproduceother
importantcompanyoutcomes–suchasaqualityculture,oraworldclasssafetyculture.It
alldependsonwhatthecompanyisfocusedonobtaining.Insimplisticthinking–flour,
sugar,andeggs–keyingredients(elements)canproducealotofdifferent,positive
62016©HERO.Allrightsreserved.
outcomes–cookies,muffins,cake,pancakes,etc.It’swhatyouaddtothemthatcreatesthe
difference.
Finally,giventhelackofaconsensusdefinitionforacultureofhealthwithinthehealthand
well-beingindustry,developmentofaconsensussetofdefinitionsunderscoresthe
milestonerepresentedbythisWorkgroupreport.Theidentificationof24agreedupon
elementsbelievedtodriveacultureofhealthisalsonoteworthy.However,morework
remainstobedone.ThenextphaseofeffortfortheCoHstudycommitteeistoconducta
literaturereviewtodeterminethestrengthandrigorofevidencesupportingeachofthese
elementsasademonstrateddriverofaCoH.TheworkoftheDefinitionsWorkgroupthus
becomesthefoundationuponwhichtheResearchWorkgroup’seffortsarebuilt.
Definitionsof24KeyElementsofCulture
CoreCultureElement
ConceptualDefinitionofElement
OperationalDefinitioninaHealthyCulture
ObservableExamplesinHealthyCulture
Norms Informalandsometimesformalguidelinesaboutwhatisconsiderednormal(whatiscorrectorincorrect)socialbehaviorinaparticulargrouporsocialunit.Normsformthebasisofcollectiveexpectationsthatmembersofaculturehavefromeachother,andplayakeypartinsocialcontrolandsocialorderbyexertingapressureontheindividualtoconform.Inshort,"Thewaywedothingsaroundhere."
Normsarerecognizedandintentionallyinfluencedbythemembersoftheculturetosupportopennessforhealthybehaviorssuchasphysicalactivity,closesocialrelationships,andhealthyeating.
Acompanyidentifiesitspriorityhealthnorm,e.g.,stretchingbeforework,acceptanceofworkingoutoverlunch,supportiveandsafeenvironmentfordiscussionsregardingwell-being.
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CoreCultureElement
ConceptualDefinitionofElement
OperationalDefinitioninaHealthyCulture
ObservableExamplesinHealthyCulture
SharedValues Explicitorimplicitfundamentalbeliefs,concepts,andprinciplesthatunderliethecultureofanorganization,andwhichguidedecisionsandbehaviorofitsemployees,management,andmembers.Sometimesreferredtoaspriorities.
Thehealthandwell-beingofpeopleisamongthetopprioritiesofanorganization.Theorganizationrecognizesemployeesasinternalcustomersandprioritizestheirneeds;thisisoftenreferredtoasapeople-centricapproach.Peoplebelievethattheycanachievehealthylifestyleswithindividualinitiative,knowledge,andasupportiveenvironment.
Acompany’sstatedvaluesincludehealthandwell-beingandarerecognizedatthesamelevelasotherkeyvalues,e.g.,quality,customersatisfaction,profitability.Healthisvaluedinrelationshiptoperformance/productivityandiscommunicatedtoemployees.
ExecutiveLeadership Executiveleadershipwhosebehaviorsreflectthatofcommittingtothevaluesofthecompanyandpracticesthatarepeople-centricandbuildstrongculturesoftrustwithintheorganization.Leadershipthatshapes,lives,andspreadspeople-centricvaluesthatdrivetheorganizationtoachieveexceptionalresults.Instillsinpeopleasenseofpurposeorbelongingandcommitmentthatisnotaresultofsomeexternalincentiveorbenefittobegained.
Leaderspersonallyembracewell-beingthroughtheevidenceofitintheirlifestyleandalsoinsupportingwell-beingintheorganizationthroughtheirdecisionmakinginfluence,resourceallocation,andpersonalengagement.
Seniorleadershipdesignatesabudgetforhealthandwell-beingactivities,participatesinwellnessactivities,etc.
OrganizationalLeadership
Leadershipisaprocessofsocialinfluenceinwhichonepersoncanenlisttheaidandsupportofothersintheaccomplishmentofacommontask.
Executives,middle-mangers,peerleaders,andchampions(1)sharethevisionforhealthandwell-being,(2)serveasrolemodels,(3)alignformalandinformalpoliciesandprocedures,and(4)trackandcelebratehealthandwell-being.
Managersandleadersatalllevelsunderstandwhyandhowtosupporttheiremployeesintheirpersonalwell-beingefforts.Theyalsoactivelyparticipateinhealth/wellnessactivities.
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CoreCultureElement
ConceptualDefinitionofElement
OperationalDefinitioninaHealthyCulture
ObservableExamplesinHealthyCulture
Communication Measurement,feedback,andaccesstoknowledgeprovidedbythegroup.Avarietyofcommunicationvehiclesandchannelsareusedthroughouttheorganizationonaregularbasistoensurethateveryoneisfullyawareofthestatusoftheorganization,currentandfutureactionsplanned,andeveryone’srole,etc.Formalandinformalprocessesforinputandfeedbackfromallconstituentgroupsandstakeholdersareactivelyobtainedanddisseminated.
Peoplegetregularfeedbackabouthowtheyandthegrouparedoinginachievinghealthylifestyles.Theyarealsokeptabreastofsuccessstoriesandresourcesavailableforpursinghealthandwell-being.Thepopulationisengagedinanongoingconversationabouthealth,itsvaluetoboththeindividualandtheorganization,andchangeinhealthstatusovertimeaswellasimpactontheorganizationovertime.
Newsletters,smallgroups,businessupdates,townhallmeetings,digitalsignage,intranet,socialmediathatopenlycommunicatehealthandwell-being.
Recruitment&Selection
Selectionandrecruitmentarestrategicallyalignedtotheorganization’svaluesandisintentionallydesignedtoachievespecificoutcomes.
Theorganizationhasareputationforbeingagreatplaceforhealth-orientedindividuals,andonethatpromotesmeaningfulwork,work-lifebalance,moralcongruenceofwork,empowerment,andself-worth.Theopportunitytopursueahealthylifeisoneoftheprimarybenefitsofemployment.Well-beingisfactoredintorecruitment,selection,promotions,andinternalplacements.
Personalwell-beinginterestandpropensitytoembracewell-beingisincludedinselectionquestionsandevaluationprocess–similartootherperformanceattributes.
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CoreCultureElement ConceptualDefinitionofElement
OperationalDefinitioninaHealthyCulture
ObservableExamplesinHealthyCulture
Metrics&Measurement Theorganizationhasestablishedmetricsandmeasurementsystemsthatprovidevisibleandtimelyfeedbackonperformance.Leadersandmanagersareheldaccountabletomeettheperformancemeasuresandthesemeasuresdriveresourceallocationanddecisionmaking.
Specificwell-beingmeasurementsareestablishedandsharedwithallemployees.Theresponsibilityforperformanceincludesthehealth&well-beingoftheworkforce.Employeesarerecognizedascontributingsignificantlytotheoverallvalueoftheenterprise.
Acompanymayhavemetricsandcommunicationonreducingthepopulationofmetabolicsyndrome,overallhealthcarecosts,tobaccousage,orincreasingvolunteerism.
Policies&Procedures Theorganizationhas“formal”policiesandproceduresthatareclearlyalignedwiththevaluesoftheorganizationandaredesignedwithintenttosupportthosevalues.
Specificwell-beingpoliciesandproceduresareestablishedandactiveintheorganizationtosupportacultureofwell-being.
Tobaccofreecampus,stretchingprograms,leavepolicies,etc.
SupportiveBuiltEnvironment
Thebuiltenvironmentissupportiveofactivitiesthatarealignedwiththevaluesoftheorganization.
Dedicatedfinancialandhumanresourcesareavailableforsupportofwell-beingsystemsandprograms(i.e.,adequatefinancialresources,budget,andhumanresources).
Staffingincludeswellnessresources,e.g.,wellnessmanager,externalproviders,programs.
OrganizationalResourceAllocation&Commitment
Organizationalresourcessuchasfinancialandhumanresourcesarededicatedtotheprioritiesofthebusinessasdictatedbythevaluesofthecompany.Time,resources,spaceareadequatetomeetobjectives.
Dedicatedfinancialandhumanresourcesareavailableforsupportofwell-beingsystemsandprograms(i.e.,adequatefinancialresources,budgetandhumanresources).
Staffingincludeswellnessresources,e.g.,wellnessmanager,externalproviders,programs.
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CoreCultureElement ConceptualDefinitionofElement
OperationalDefinitioninaHealthyCulture
ObservableExamplesinHealthyCulture
EmployeeInvolvement&Empowerment
Employeesareactivelyengagedindecisionmakinginallaspectsofthebusiness.Inaddition,theyareempoweredandprovidedampleautonomyandworkercontroltoaffordhealthyworkengagementlevels.
Employeesareactivelyengagedinwell-beinginitiatives.Theyserveasbothformalandinformalleadersinsupportofwell-being.Throughouttheorganization,employeeleadersareinvolvedandempoweredtopromote,encourage,model,andinstillhealthandwell-beingvaluesoftheorganization.
Wellnesscommittee,employeesengagedasleadersofwell-beingactivitiesincludingvolunteerism,basketball,runningclubs,etc.
Rewards&Recognition Rewardsandrecognitionarewaysaculturereinforcesdesiredbehaviorthroughtangiblerewards(suchasmoneyorprizes),throughrecognition(suchaspraise,acknowledgementandexpressionsofgratitude),andthroughpromotion(suchascareeradvancement).Rewardsandrecognitionarebothextrinsicandintrinsicinnature.
Peoplearerewardedandrecognizedforhealthybehavior,andindividualandgroupachievement.
Healthclubreimbursement,prizesforhighesthealthclubutilization,andunhealthypracticesarediscouragedornotrewarded,e.g.,tobacco-freediscountsonhealthpremiums.
PeerSupport Peersupportoccurswhenfriends,family,neighbors,andcoworkersprovideknowledge,experience,andemotional,social,orpracticalhelptoeachother.
Employeesadopthealthylifestyles,sharehowtheyachievedhealthypractices,participateinhealthinitiatives,andhelpotherswiththeirjourney.
Formalwell-beingaccountabilitypartnerssuchasapartnerinawellnesschallenge(steps,healthyeating,etc.),andinformalaccountabilitywhereasupportive,caringatmospherehasbeencreatedandencouragedforthissupport.
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CoreCultureElement ConceptualDefinitionofElement
OperationalDefinitioninaHealthyCulture
ObservableExamplesinHealthyCulture
PushBack Push-backiswhenmembersofacultureexpressdispleasurewithabehavior.Push-backissynonymouswithconfrontation.
Unhealthybehaviorisconfrontedandhealthybehaviorisrarelyconfronted.
Anonsmokerwouldfeelcomfortableandcompelledtoconfrontanindividualwhoisviolatingatobacco-freecampuspolicy.Theoppositewouldbewhereanindividualknowsthatheorshewouldnotbenegativelyconfrontedforaformalwalkingormeditatingbreak.
SenseofCommunity Asenseofcommunityexistswhenpeoplefeelthattheybelong,gettoknowoneanotherbeyondtheirjobs,mattertooneanother,trustoneanother,helponeanother,andseeafuturetogether.Healthyrelationshipscharacterizedbysocialandprofessionalinteractionsthatfosterasenseofbelongingandcoherenceexist.
Asenseofcommunityissupportedthroughhealthyrelationshipsthatarethesocialandprofessionalinteractionsthatfosterasenseofbelonging,coherenceandwell-being.Healthyrelationshipsarecharacterizedbyopencommunication,mutualrespect,mutualsupport,collaboration,andtrust.
Theworkenvironmentismorethan“work.”Peopletakeaninterestinthelifeoutsideofworkanddothingstogetheroutsideofworkbecauseofthecommunitybuiltwithintheworkenvironment,e.g.,campingtrips,golfleagues.
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CoreCultureElement ConceptualDefinitionofElement
OperationalDefinitioninaHealthyCulture
ObservableExamplesinHealthyCulture
SharedVision&Mission Asharedvisionexistswhenpeopleare(1)inspiredbythedirectionandpurposesofthegroup,(2)feelthatothergroupmembersareworkingtoachievethesamegoals,(3)seehowtheirowneffortssupportthegroup,and(4)feelthatthewaythingsaredoneisconsistentwiththeirpersonalvalues.Sharedvisionisanagreeduponsetofexplicitorimplicitfundamentalbeliefs,concepts,andprincipleswhichguidedecisionsandbehaviorofemployees,management,andmembers.Thevisionandmissiontranslatethosevaluesintoguidingstatementsaboutwhotheorganizationstrivestobeandhowitwillgetthere.
Thecompanyhelpspeoplefeelinspiredthattheirwell-beingeffortsareimportantandalignwithandbenefitthebroaderorganization.
Highlightinghowhealthylifestylesdrivedownhealthcarecoststhatcanbereinvestedintheorganizationorlowerpremiumsforeveryone.Sharingacommunityorvolunteerismreportcardwhichillustratesthepositiveimpactofvolunteerisminthecommunity.
PositiveOutlook Apositiveoutlookexistswhenpeople(1)recognizeeachother’sstrengths,(2)approachworkandchallengeswithenthusiasm,and(3)havefuntogether.
Thereisrecognitionthatourstrengthshelpusmoveforward.Individualsandworkteamsseetheopportunitiesineverydaychallenges.
Cultureand/oropinionsurveysillustrateastrongthemeofoptimismandpositivitytowardco-workersandthecompanyingeneral.
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CoreCultureElement ConceptualDefinitionofElement
OperationalDefinitioninaHealthyCulture
ObservableExamplesinHealthyCulture
Modeling Individualsvisiblydemonstratethedesiredbehaviorwithintheculture.
Individualsthroughouttheorganizationadopthealthylifestyles,sharehowtheyachievedhealthypractices,andparticipateinhealthinitiatives,thusdemonstratingthathealthylifestylechoicesareachievableandhighlybeneficial.Inaddition,leaderswhoarerespectedwithintheorganizationmodelhealthybehaviors.
Leadershipworksoutincompanygymvs.healthclubtomodeltherightbehavior.Groupmeetingsoverlunchorderhealthymenuvs.pizzaorunhealthyoptions.
Orientation&FirstImpressions
Theformalandinformalexperienceofnewmembersoftheculture.
Newpeoplearemadeawareofalltheresourcesandsupportavailableforlivingahealthylifestyle.
Newemployeeorientationincludesoverviewofwellnessprogramsandinitiatives.
Training&Learning Theskillsandexperiencethataretaughttomembersofagroup.
Lessonssharedbypeersandformaltrainingteachskillsforlivingahealthylifestyle.
Trainingandlearningcurriculumincludeswell-beingtopics,e.g.,financialmanagement,parentingclasses,dietingandnutrition,sleepseminars.
RelationshipDevelopment
Theformalandinformalwaysbywhichindividualsestablish,maintain,andfosterfriendships,formteams,andcollaboratetogether.
Socialrelationshipsareformedaroundhealthybehaviors.Healthyactivitiesareprimarywayspeoplemeetnewpeople,maintainfriendships,formteams,andstrengthenworkrelationships.
Sportsteams,basketballleague,fitnessclasses,etc.
Traditions&Symbols Atraditionisarecurringbehaviororactivitypasseddownwithinagroupthathascometohavespecialsignificance.Asymbolissomethingthatthegrouphasassignedspecialmeaning.
Traditionssuchasholidayshavebeenrevisedsothattheyincorporatehealthybehavior.Newwellnesstraditionsarecreatedsuchasoutingsthatincludephysicalactivityandannualconteststhatfeaturehealthybehavior.
“YellowJersey”(likeTourdeFrance)forpeoplethathaveaccomplishedsignificantwellnessachievements.WellnessChampionsrecognizedonawalloffame.
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CoreCultureElement ConceptualDefinitionofElement
OperationalDefinitioninaHealthyCulture
ObservableExamplesinHealthyCulture
InternalCustomerOrientation
Viewingemployeesasinternalcustomers,includingassessingneeds,developingandimplementingagreed-uponprocesses,developinganddeliveringproductsandservicesthatsatisfyneeds,periodicallyassessingresultsandmakingnecessaryadjustments.
Aninternalcustomerorientationisusedtofocusonthehealthandwell-beingneedsoftheemployeesresultingincontributiontotheobjectivesoftheorganization.
Needsassessmentsthatareperformedinanorganizationtakeintoaccountwell-beingneedsofthepopulation.
ExternalCommunityConnections&Altruism
Intentionallysupportingtheexternalcommunityasanextensionofyourworkplaceenvironment,recognizingtheimportanceofsupportingthegreatercommunity.Theeffortsarealtruisticinnatureandinvolvedoingthingssimplyoutofadesiretohelp,notbecauseyoufeelobligatedtooutofduty,loyalty,orreligiousreasons.
Managementandemployeesregularlyvolunteerinthecommunitytosupportneedycausesandcharitableorganizations;sponsorhealth-relatedcommunityactivitiesandeventsandwillprovideanenvironmentatworkthatopenlysupportsthelessthisthinking.
VolunteeringtoteachJuniorAchievement,servingmealsatahomelessshelter,adoptahighway,BigBrothers/BigSisters,etc.
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