Miranda Dally, MS, University of Colorado Anschutz Medical Campus; Lynn Dexter, MS MPH, University of Colorado Anschutz Medical Campus; Liliana Tenney, DrPH, University of Colorado Anschutz Medical Campus; Carol Brown, PhD, University of Colorado Anschutz Medical Campus; Lee Newman, MD MA, University of Colorado Anschutz Medical Campus
The purpose of this study is to characterize small businesses by their organizations’ Total Worker Health (TWH) approach — business strategies, leadership, and climate; and to assess the relationship of these approaches to employee health and safety behaviors. Using latent profile analysis, we hypothesized that there would be four business TWH profiles: Beginner profile, Business strategy-focused, Culture-focused, and Advanced. We also hypothesized that employees who worked for businesses with higher TWH business profile scores would report better safety and health behaviors than employees who worked for businesses with lower TWH business profiles scores.
The TWH approach is emerging as a best practice method to protect and promote worker safety, health, and well-being. Leadership support and the creation of health and safety climates that that support day-to-day engagement in health and safety policies and programs are central to the TWH approach. This is because employees will be more likely to participate in efforts to protect and promote their health if they work in an environment that cares about their health. While some research supports the relationship between leadership support, safety climate and health climate, and employee participation, there has been limited research amongst small businesses. Furthermore, it remains to be shown what role TWH business strategies, the organizational policies and programs to protect and promote employee health, play in the relationship between leadership support, safety climate and health climate, and employee participation.
The businesses in this study are part of the Small+Safe+ Well (SSWell) intervention study. We utilized cross-sectional data before intervention participation. One person from the business completed the 35-item business-level Healthy Workplace Assessment. The assessment measures existing evidence-based TWH strategies across 6 core benchmarks: organizational supports, workplace assessment, health policies and programs, safety policies and programs, engagement, and evaluation. All employees were asked to complete a survey. We developed the leadership commitment to safety (5-items) and leadership commitment to worksite wellness (5-items) scale. For safety climate, we used Lee et al.’s organizational commitment to safety measure (5-items). For health climate, we used Zweber et al.’s organizational commitment to health measure (4-items). Finally, safety behaviors (3-items) and health behaviors (3-items) were measured by adapting Griffin and Neal’s safety participation scale.
We conducted an LPA at the business level. We calculated ICC(1) and r*wgj prior to aggregating responses to the business level. Fit statistics were used to select the final model. A linear regression analysis at the employee level was used to test the effect of latent profile membership on safety behaviors and health behaviors while controlling for industry, number of employees, management role, tenure, age, and gender.
Based on our selection criteria, the four latent profile solution fit the data the best and the probabilities that businesses would be assigned to their profile were high (> 0.90), indicating a low chance of misclassification. There were two profiles characterized by low (33% of businesses) and high (9%) levels of the indicators as well as profiles with two different foci on either TWH business strategies (27%) or leadership and climate (31%). Employees working in a business strategy focused, culture-focused, and advanced profiles all had significantly better behaviors than employees working for a business with the beginner profile.
Businesses often report that they have difficulty meeting their engagement goals. They often respond in a transactional way – adopting additional programs and policies. Our findings suggest that workers’ health and safety actions are strongest in those workplaces that have focused on the combination of not only its TWH policies and programs, but also on establishing leadership that establishes a climate that supports and encourages health and safety behaviors.
The results of the present study add to the occupational health and safety small business literature by identifying four ways in which small business address TWH, suggesting variation in small business approaches to TWH. These findings have significant implications for how we design small business TWH interventions.
As hypothesized, we found that employees working for businesses with advanced TWH practices reported better safety and health behaviors than did employees working for businesses with less advanced TWH practices. This is consistent with prior research demonstrating the relationship between safety and health leadership, climate, and employee behavior.
A strength of this study is the variety of businesses from multiple industries and from both urban and rural settings represented in the study. Our limitations include a lack of information on the quality of TWH business strategies and the use of cross-sectional data.
Our study demonstrates that employee engagement in TWH is associated with TWH business practices that focus on having a business strategy for how they implement a TWH approach as well as leadership commitment to these strategies and having an environment that fosters positive safety and health climates. More research is needed to understand whether small businesses can improve upon their profile overtime.