I have just moved back to Sydney. I am trying to find a builder to renovate my apartment and it is not easy. If you are lucky enough to get the attention of one of them they talk in prices so high it makes you dizzy. I was complaining about this to a taxi driver the other day (I give as good as I get when it comes to having something to say in taxis). His response was: “What do you expect, you live in Elizabeth Bay and you are old, that’s 40% extra immediately.”

I am slowly accepting that young people see me as old now. Whilst there is a lot that is not fun about ageing there are some pluses, and probably my favourite is seeing what happened next.

The integrated approach to workplace health and safety, predicted as a direction for workplace health and safety since the 1990s, is a case in point. Essentially in theory it is the combining of occupational health and safety (health protection) with workplace health promotion.

In reality it is de-siloing health and safety, workplace health promotion and human resources management to build on a foundation of safety for a more strategic effort, with a greater sharing of responsibilities between employers and workers. Integrating health protection and promotion is expected to create synergy and enhance overall health and wellbeing of the workforce, while decreasing the likelihood of workplace injury and illnesses.

 

Vic WorkHealth: An integrated approach experiment

Having banged on about it since 1986 (to my best recollection) I have been lucky enough to be able to follow an experiment with this initiated by WorkSafe Victoria.

WorkSafe Victoria had a huge WorkHealth program from 2008-2013 in which health checks and advice were offered to the entire working population.

The intervention was strengthened in the latter years with the addition of grants to workplaces for workplace health promotion initiatives and lifestyle behavioural change programs.

Modelling undertaken as a part of the evaluation by the Institute for Safety, Compensation and Recovery Research (ISCRR) at Monash University and led by Professor Malcolm Sim, showed that:

• The program had been effective in raising awareness of worker health;
• The program was likely to have achieved its goals related to reductions in absenteeism, presenteeism and claims;
• Workplace culture and support was associated with more sustainable health behavioural change;
• There was a ripple effect (mental health was not included in the program, but despite this mental health was still addressed in workplace programs); and
• Workplaces with health promotion programs had better safety cultures than those without.

It is said that the impact of a public health program is determined by its reach and its effect (how powerful it is).

In this case the impact of the program was more so due to its extraordinary reach: more than 800,000 workers, about a third of the Victorian workforce, and around 40,000 workplaces. The evaluation found that the quality of the interventions, ie the effect, could have been improved.

In July 2014 WorkSafe Victoria working in partnership with the Department of Health and Human Services (DHHS), as well as through their long-standing social partnerships with employer organisations and unions.

Expanding program for a WIN

WorkSafe and DHHS (above) decided to continue to explore the potential of the integrated approach to advance worker health, safety and wellbeing with another program, The WorkHealth Improvement Network (WIN).

At this point I should declare that I was involved with the evaluation of WorkHealth, described above, as well as the conceptualisation of WIN, and was a technical advisor to WIN for the past two years.

The theoretical underpinning of the WIN was based on three concepts:

1. The integrated approach
2. Continuous improvement – Specifically the (plan, do, study, act) methodology, described in health as ‘collaboratives’: small cycles of improvement, ‘permission to fail’
3. Partnership – Using already established networks of workplaces run by third parties to reach workplaces.

Three priority issues, considered to be influenced by a combination of work-related and non-work-related risk factors, were selected for the program: musculo-skeletal disorders, mental wellbeing and safety culture.

Manufacturing and health were selected as priority industries and the Victorian Chamber of Commerce and Industry (Victorian Chamber) and the Public Hospitals Network in the DHHS agreed to develop and manage the networks in their respective industry.

Through ISCRR, a research team drawn from the University of Melbourne and Monash University was appointed to provide information to assist workplaces with their improvement programs and address three evaluation questions for the program as a whole, related to:

• the optimal way for the integrated approach to advance OHS;
• what capacity must be built for sustainability; and
• the costs and benefits to employers and workers.

In three waves, 15 manufacturing worksites and 16 hospitals were recruited into the program.

The WIN learnings

On October 19, 2016, a function was held at the Melbourne Cricket Ground to celebrate the WIN program and to share learnings. For me it felt like I was looking at WHS in transition to the future.

Leaders from the three key partners: WorkSafe Victoria, Victorian Chamber and the DHHS, presented their views on the learnings from their experience; in addition several of the projects presented their conclusions.

Major learnings included:

• The changing nature of work and the rise of chronic disease is driving an evolution of prevention in worker health
• The integrated approach was seen as beneficial. It was agreed that the major selling point was the gains in terms of health, quality and productivity through an integrated approach to risk (work and non work health risks)
• The term ‘integrated approach’ had two meanings:

1. Integration of work-related and non work-related risk factors (the term holistic was often used as an alternative)
2. Integration of the work across various business units including safety, health promotion, human resources management and quality

• For the manufacturing industry, often (but not always) the integrated approach had been a means of building on a strong foundation of safety to tackle health issues, especially mental wellbeing
• For the health industry, which already has a consciousness of wellness, it had been used to improve the foundation of safety
• The methods of the program had led to, with positive results:

1. a broader engagement across business units and with staff than usually occurred
2. identification of issues of local relevance

• Learning from each other was valued at all levels:

1. central, through the partnerships
2. industry, exchange between the manufacturing and health networks
3. organisation (peer to peer within and between networks)

• Dealing with the regulator in a voluntary capacity had initially been of concern for many, but once boundaries were established, access to the expertise available at and through WorkSafe was valued
• Leadership was critical, especially for the establishment of goals and obtaining commitment for the resources required to run the projects in workplaces
• Readiness for the intervention was an issue that required further consideration – one dimension of this was whether the WHS program was sufficiently mature to provide a foundation for the integrated approach, another related to leadership, commitment and resourcing

 

Continuous improvement plus integrated approach

Further learnings (above) were:

• Introducing a continuous improvement methodology at the same time as the integrated approach had made the program complicated; however the idea of taking small steps in a safe to fail environment had been useful
• Overall workplaces liked having research reports for each of their workplaces, but more work was required on knowledge translation to improve its utilisation by them

Data is still being collected by the University of Melbourne and Monash University evaluation team, and the results are not due until after April next year.

Next steps

In the meantime:

• the Victorian Chamber is preparing case studies with the view to promulgation more broadly through their membership;
• WorkSafe is continuing to work with their Health Practice Team using this approach, and are looking to adopting the integrated approach for improving the health of their own staff; and
• the DHHS is looking forward to drawing on the partnership with WorkSafe and the Victorian Chamber in taking this approach to tackling occupational violence and bullying.

I, and my superannuation fund, have given myself another 20-25 years. So if I die before my Sydney apartment gets renovated, and at this stage that seems highly likely, at least I will be dying happy in the knowledge that 30 years after I first talked publicly about it, the integrated approach has seen the light of day of Australia.

In the words from Kylie Minogue’s Celebration, ‘It’s time to come together’.

 

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First published in Thomson Reuters Inside OHS, 02 November 2016

Inside OHS Editor: Stephanie D’Souza; (02) 8587 7684; Stephanie.D’Souza@thomsonreuters.com